Surgical treatment of unstable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients

C Faldini,S Giannini,O Faldini,M Romagnoli,V Digennaro,G Grandi,S Pagkrati

doi:10.1007/s10195-006-0133-x

Abstract

A retrospective study was conducted to assess the complications, clinical and functional outcomes at 5 years of follow-up of a series of elderly osteoporotic patients with an unstable intertrochanteric fracture treated by bipolar or total hip replacement. Fifty-four patients with an A2 intertrochanteric osteoporotic fracture were identified between 1996 and 2000. The average age of the patients was 81 years (SD=5). The follow-up time was 5 years. Patients received a bipolar or total hip replacement. During follow-up, we analyzed postoperative complications, mortality rate, functional results using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. One patient died intraoperatively; two patients died on the third and eighth postoperative days and seven patients died within 1 year. Twenty-five patients were living at the 5-year follow-up. Harris hip score at 1 month was 64±8 (mean±SD); at 3 months, 75±5; at 1 year, 76±5; and at 5 years, 76±9. Weight-bearing was permitted immediately after surgery, as tolerated. Time to return to normal daily activities was 27±5 days. No loosening or infection of the implants were observed. In elderly osteoporotic patients with an unstable intertrochanteric fracture, bipolar or total hip replacement in association with reduction of the greater trochanter is a valid alternative to the standard treatment of internal fixation. This surgical technique permits a more rapid recovery with immediate weight-bearing, and a maintenance of a good level of function, with little risk of mechanical failure.

Highlights

A debated topic in trauma surgery is the type of operation and the short- and long-term results of reduction and fixation of unstable trochanteric fractures
In elderly osteoporotic patients with an unstable intertrochanteric fracture, bipolar or total hip replacement in association with reduction of the greater trochanter is a valid alternative to the standard treatment of internal fixation
Many methods for treating intertrochanteric fractures (IF) have been developed, from medial displacement osteotomy [1] and condylocephalic intramedullary Ender nailing [2], to use of the more modern sliding hip screw [3,4,5], cephalomedullary nails [3, 6, 7], external fixators [8,9,10,11,12] and their variants, which represent the gold standard in this kind of surgery

Summary

Introduction

A debated topic in trauma surgery is the type of operation and the short- and long-term results of reduction and fixation of unstable trochanteric fractures. Local complications (such as cutting out of the fixation devices from the femoral head, nonunion, shortening and external rotation of the limb, varus neck shaft angle deformity) [1, 2, 4, 10, 12, 16,17,18,19] are considerable, as is mechanical failure of the fixation or loosening of the reduction in the postoperative period. The main causes of mechanical failure are comminuted or unstable fractures [18, 19] and osteoporotic bone [16, 17]. The coexistence of unstable, comminuted fractures with osteoporosis worsens the prognosis [16]

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