Trochanteric reconstruction and long-stem bipolar hemiarthroplasty to treat unstable intertrochanteric fractures in elderly patients

Abstract

Objective To investigate the clinical efficacy of trochanteric reconstruction and long-stem bipolar hemiarthroplasty in the treatment of unstable intertrochanteric fractures in elderly patients.Methods From December 2003 to May 2012,we used trochanteric reconstruction and long-stem bipolar bemiarthroplasty to treat 41 elderly patients with unstable intertrochanteric fracture.They were 15 men and 26 women,aged between 75 and 101 years (average,87.2 years).By Evans classification,there were 8 cases of type Ⅲ A,12 cascs of type Ⅲ B and 21 cases of type Ⅳ.Diabetes was complicated in 11 cases,primary hypertension in 23 cases,pulmonary insufficiency (level Ⅱ) in 5 cases,and cardiac insufficiency in 17 cases;6 cases had a history of cerebral infarction.Osteoporosis of varying degrees was found in all cases.By Singh indexes,9 cases were graded as Ⅰ,15 eases as Ⅱ and 17 cases as Ⅲ.Under lumbar plus epidural anesthesia,the troc hanteric fractures were reconstructed to almost restore the anatomic structures after the femoral head had been amputated,and procedures of long-stem cemented bipolar hemiarthroplasty followed the fixation of the fractures. Results The operation time ranged from 60 to 110 minutes (average,82.3 minutes),and the blood loss from 400 to 800 mL (average,523.6 mL).All incisions healed without wound infection and no postoperative dislocation was observed.Thirty-nine cases were followed up for 12 months to 66 months (average,41.3 months).Five patients died 18 to 38 months after surgery due to cardiovascular and cerebrovascular accidents.By the Harris scores at the last follow-up,26 cases were excellent,11 cases good,and 2 cases fair,with a good to excellent rate of 94.9％.No joint dislocation or stem prosthesis sinking was observed in this series. Conclusions In treatment of unstable intertrochanteric fractures in elderly patients,long-stem cemented bipolar hemiarthroplasty can lead to satisfactory outcomes.The key to surgical success is the trochanteric reconstruction. Key words: Hip fractures; Arthroplasty, replacement, hip; Treatment outcome; Reconstruction