Treatment Of Unstable Intertrochanteric Fractures Research Articles

Dynamic Hip Screw (DHS) versus Proximal Femoral Nail Anti-rotation (PFNA) Fixation for Unstable (Evans-Jensen II and III) Inter-trochanteric Fractures of Femur in Elderly

Background: Dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) are the two most commonly used fixation devices for inter-trochanteric fracture of femur. However, many clinical studies have shown lack of differences in the clinical outcome consistently with between these two fixation techniques. The main objective of this study is to compare the results of dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) fixation in elderly patients with unstable inter-trochanteric fractures of femur.
 Methods: We retrospectively reviewed patients who underwent operative management for inter- trochanteric fractures of femur in our hospital between February 2013 and September 2017. Elderly patients (Age >60yrs) with unstable inter-trochanteric fracture of femur treated either with DHS fixation or with PFNA fixation were included and divided into two groups: DHS fixation group and PFNA fixation group. The comparative statistical analysis was done between two group using following parameters: average length of the incision, operation time, blood loss, fracture healing time, and degree of postoperative functional recovery.
 Results: The mean follow-up period, in DHS fixation group was 16 month (range 12 to 24 months) and in PFNA fixation group was 14 months (range 12 to 18 months). The differences between two groups regarding average length of the incision, operation time, and blood loss were statistically significant (p<0.05) and better in PFNA group whereas the differences between two groups regarding fracture healing time and the degree of postoperative functional recovery were not statistically significant (p >0.05).
 Conclusions: PFNA fixation may be better than DHS fixation for the treatment of unstable inter-trochanteric fractures of the femur in the elderly. However, the application and usage of DHS fixation could not be neglected and the choice of treatment depends upon the systemic condition and socioeconomic status of the patient, patient’s preferences, surgeon’s experience and availability of treatment facility.

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture Post Dynamic Hip Screw Fixation

IntroductionIntertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate. The most commonly used devices are the dynamic hip screw (DHS) with side plate assemblies and proximal femoral nail (PFN). The aim of this study was to determine the functional and radiological outcome of unstable intertrochanteric fracture post DHS fixation at a tertiary care hospital in Karachi, Pakistan.MethodsA study was carried out in the department of orthopedics at the Jinnah Postgraduate Medical Center (JPMC), from 12th June 2016 to 8th September 2017. A total of 106 patients between 18 and 75 years of age with unstable intertrochanteric fracture were included. Those patients who had multiple injuries and open fractures, subtrochanteric fractures, intracapsular fractures neck of femur, pathological fractures and patients who were non-ambulatory prior to their injury were excluded. Functional outcomes were measured both during pain using the visual analog scale and range of motion on goniometer between 80 and 100 degrees. Satisfactory outcomes were measured after three months.ResultsA total of 106 patients with the radiological diagnosis of the unstable intertrochanteric fracture having post DHS fixation were included in this study. Out of which, 69.8% (74) were males and the mean age was 66.61 ± 7.79 years over the range of 50 to 80 years. Patients with type II diabetes were 22.6% (24) with a mean duration of 4.3 ± 8.37 years. At the end of three months, no pain was reported in 82.1% (87) patients and 85.8% (91) patients had normal function. The satisfactory radiological outcome was observed in 86.8% (92) patients. Overall, acceptable outcomes were observed in 81.1% (86) patients at the end of three months.ConclusionThe treatment of unstable intertrochanteric fracture with dynamic hip screw (DHS) fixation results in better outcomes. In our study, we observed acceptable outcomes in a vast majority, 81.1%, of patients after three months of DHS fixation of the unstable intertrochanteric fracture.

Analysis of outcome of proximal femoral nailing in unstable trochanteric fractures: A prospective study

Inter-trochanteric fractures are the common fractures of hip which occurs in young adults as a result of high velocity injury and in osteoporotic elderly due to low velocity injury. Inter-trochanteric fractures are treated by various surgical modalities. Proximal femoral nailing is now been used widely for the treatment of unstable inter-trochanteric fractures. The clinical and radiological outcomes are good with low rates of complications. We prospectively studied 36 unstable inter-trochanteric fractures treated with proximal femoral nailing. The overall functional result was assessed by the Harris Hip Score which was Excellent in 13.34%, Good in 41.67%, Fair in 19.44% and Poor only in 5.55%.

Use of an injectable complex of β-tricalcium phosphate granules, hyaluronate, and fibroblast growth factor-2 in the treatment of unstable intertrochanteric fractures with bone defects

Use of an injectable complex of β-tricalcium phosphate granules, hyaluronate, and fibroblast growth factor-2 in the treatment of unstable intertrochanteric fractures with bone defects

A comparative study of the results of unstable intertrochanteric fracture treated with cemented bipolar hemiarthroplasty with and without reconstruction of the greater trochanter

Background: Osteosynthesis of unstable intertrochanteric fractures (IT) in elderly population, needs prolonged rest to prevent implant failure which in turn results in many complications. Cemented bipolar hemiarthroplasty has been the established method of treatment for unstable intertrochanteric fractures in literatures. Our study aimed to compare the effectiveness between reconstruction of greater trochanter V/S without reconstruction of Greater Trochanter in Unstable intertrochanteric fractures treated with cemented bipolar. Materials and Methods: 40 elderly patients with unstable IT femur fractures were included in the study of which 24 patients underwent Reconstruction of greater trochanter and in remaining 16 greater trochanter reconstruction were not done. Clinico radiological evaluation was done at 6 weeks, 3 months and 6 months. The functional outcome between the 2 techniques was evaluated using Harris hip score. Results: It was found that, there is statistically significant difference in functional outcome between the 2 groups at the end of 6 weeks, 3 months and 6 months (p

Outcome of primary cemented bipolar hemiarthroplasty in older patients with unstable hip fracture: A prospective study

Objective: Internal fixation as a classical method of treatment for unstable intertrochanteric fractures in older patients has significant complications and failure rate. This raises the need for a method that overcomes these difficulties and gives a better outcome. This study aims to evaluate the outcome of the use of primary cemented bipolar hemiarthroplasty in older patients with unstable intertrochanteric fracture both clinically and functionally. Methods: A prospective case series study conducted from January 2014 to February 2016 including 60 patients (>65-year-old) who were treated by primary cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures (Kyle 3 and 4). Main outcome measurements were clinical and mechanical complications, mortality rate, and functional outcome. Results: Early mobilization was good, that 93.3% of patients started partial weight-bearing on the 1st postoperative day. At the final follow-up (mean 13.66 ± 5.9 months), the general and mechanical complications were few; 1-year mortality rate was 16.7%; the mean Harris Hip score was 91.14 ± 5.7. Conclusions: Primary cemented bipolar hemiarthroplasty offers early, pain-free mobility with minimal complications and good functional outcome in older patients with unstable intertrochanteric fracture.

Effect of Gamma 3 intramedullary nails in treating unstable intertrochanteric fractures in the elderly

Objective To investigate the clinical effect of Gamma 3 intramedullary nails for the treatment of unstable intertrochanteric fractures in the elderly. Methods A total of 36 elderly patients (aged over 70 years)with unstable intertrochanteric fractures (Evans type Ⅲ or above)treated with Gamma 3 intramedullary nails from January 2013 to December 2016 were followed up and analyzed. Results All patients were followed up for 6 to 12 months, with an average of (9.4±2.6)months.The fractures were healed in all patients, and the healing time was between 10 and 18 weeks, with an average of 14 weeks.A mild type of coxa varus was found in 2 cases.According to the Harris hip score, the curative effect was excellent in 24 cases, good in 7 cases, fair in 3 cases and poor in 2 cases.The excellent and good rate was 86.1%. Conclusions The gamma 3 intramedullary nail is an outstanding internal fixation tool for the treatment of unstable intertrochanteric fractures in the elderly, with such advantages as minimal trauma, short operation time, firm fixation and few postoperative complications. Key words: Femoral fractures; Internal fixators

Implant options for the treatment of unstable femoral intertrochanteric fractures

Femoral intertrochanteric fracture, accounting for about 50% of hip fractures, is one of the common fracturein elderly patients and arguably the most important public health problem faced by orthopedic surgeons. Early surgical interventions, which are of benefit to early restoring limb function and reducing post-operative complications, have gradually become the optimal solution to treating femoral intertrochanteric fractures. Intramedullary andextramedullary fixation methods are two of the widely used techniques for surgical interventions. The dynamic hip screw (DHS) had been considered the standard fixation devicefor treating stable femoral intertrochanteric fractures. For unstable femoral intertrochanteric fractures, early reports suggested somesubstantial advantages in association with intramedullary devices, including a minimally invasive surgical technique, shortened operating times, improved biomechanics, greater stability of fixation, earlier patient mobilization and shorter lengths of stay. In the last 10 years we have also seen the introduction, increasing acceptance and use of the proximal femoral locking compression plate (PFLCP) in preference to the DHS, for the treatment of unstable femoral intertrochanteric fractures. It could provide angular stable plate and optimal fixation of highly unstable fractures associated with greater shearing and pull-out forces. However, the optimal fixation method of treating unstable femoral intertrochanteric fractures remains controversial. For the unstable femoral intertrochanteric fracture, intramedullary fixation has superiority in the biomechanics, because it more closes to the center of gravity and its force arm is shorter. Intramedullary nail can resistthe conductive stress along with calcar femoral well and can prevent the femoral shaft ingression. As the intramedullary nail provides more stability and allows for earlier weight bearing than the PFLCP when used for the treatment of unstable intertrochanteric fractures of the femur. While PFLCP are associated with a high complication rate, so intramedullary nailing was more beneficial for patients with an unstable femoral intertrochanteric fracture.

Effects of hemiarthroplasty with different hip prostheses on prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients

Objective To investigate the effects of hemiarthroplasty with different hip prostheses on the prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients. Methods A retrospective case series study was conducted on the clinical data of 556 elderly patients with unstable osteoporotic femoral intertrochanteric fractures treated with hemiarthroplasty from January 2008 to December 2014. There were 142 males and 414 females, aged (83.1±6.9) years (range, 75-103 years). The T value of bone mineral density was -3.5--2.5 SD [(-2.8±0.2)SD]. There were 306 cases of type A2.2 and 250 cases of type A2.3 according to AO classification. There were 296 cases of cement type and 260 biological type according to prosthesis type. Operation time, blood loss, time for ambulation, Harris hip score, and incidence of perioperative major complications were used to compare the therapeutic outcomes between the two types of prostheses. Results The operation time[(75.5±9.2)minutes], blood loss [(992.9±94.2)ml], and time for ambulation[(7.1±1.8)days] in cement type group were all less than those [(86.1±9.3)minutes, (1 139.5±96.0)ml, and (8.6±2.1)days] in biological type group, but the lung infection rate (19.9%), incidence of cardio-cerebrovascular complications (15.9%) and total death rate (7.1%) in cement type group were significantly greater than the those (13.5%, 8.8% and 1.9%) in biological type group (P 0.05). Conclusions In the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients by hemiarthroplasty, the use of cement type prosthesis can reduce operation time, blood loss and bed rest time, but it will lead to significant increases of cardio-cerebrovascular complication and overall mortality. The prosthesis type has no significant effect on the improvement of hip function. Key words: Arthroplasty, replacement, hip; Aged; Osteoporotic fractures; Femoral fractures

Early results of primary bipolar hemi arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients: A prospective study

Background and Objectives: Unstable intertrochanteric fracture in elderly is a challenging surgical condition with a high risk of morbidity and mortality. The aim of this study is to evaluate the results of bipolar arthroplasty as an alternative to the standard treatment of internal fixation. Methods: This prospective study was conducted at Department of Orthopedics, Government Medical College, Jammu from October 2014 to May 2017. Records of total 34 patients with unstable intertrochanteric fractures treated under our hospital's Orthopedic Department were analyzed. Results: Out of 34 patients enrolled in the study, 2 patients died during the study, hence the results of remaining 32 patients were analyzed with an average follow-up of 12 months. The average age of the patient was 79.35 years (range 70-94 years). The average surgery time was 82.53 min (range 62-110 min). The average intraoperative blood loss was 409.37 cc and average stay in the hospital was 14.53 days (range 5-21 days). At 1-year follow-up with help of Harris Hip Score, 8 patients (25%) were graded as excellent, 10 patients (31.25%) as good, 10 (31.25%) as fair, 2 (6.25%) as poor, and 2 (6.25%) as failed. Interpretation and Conclusion: Treatment of unstable intertrochanteric fractures in elderly patients with cemented bipolar hemi arthroplasty results in reduced complications of prolonged immobilization and easy rehabilitation along with rapid return to functional level.

Dynamic Hip Screw Versus Proximal Femoral Nail in Treatment of Unstable Intertrochanteric Fracture of Femur AO/OTA Types 31 A2 and 31A3 in Patients above Sixty Years Old. A Comparative Study

Background and objectives: Intertrochanteric fracture of the femur is one of the common and challenging fractures in the orthopedic field, which mostly affect old osteoporotic patients. Different method of fixation used to treat inter- trochanteric fracture of femur, including dynamic hip screws and proximal femoral nail .We compared the dynamic hip screw and proximal femoral nail methods of fixation in unstable intertrochanteric fracture of femur (AO Types A2 and A3) with respect to duration of surgery, blood loss, intraoperative complications, union rate and functional return. Methods:A prospective randomized and comparative study was conducted on forty two patients, 26 males (61.9%), 16 females (38.1%), from March 2015 to March 2017. Out of 42 cases, 20 patients (47.6%) treated with dynamic hip screw (group A) and 22 patients (52.4%) with proximal femoral nail (group B). In this study, maximum age was 80 years and minimum was 60 years old with a mean age of 70.9 years. Results: Our study found that proximal femoral nail fixation had relatively lesser operative time (74.5+2.6 minutes in dynamic hip screw group and 57+2.3 minutes in proximal femoral nail group), less blood loss observed (150±10.7 ml in dynamic hip screw group and 90±6.7 ml in proximal femoral nail group) and the patients were capable of early mobilization and lesser rates of implant failures (2 cases in dynamic hip screw group with no case in proximal femoral nail group), however, dynamic hip screw patients showed faster fracture healing (12-16 weeks in dynamic hip screw group and 16-24 weeks in proximal femoral nail group). Conclusions:Proximal femoral nail provides more stable fixation for unstable intertrochanteric fractures spe- cially AO type 31A3 and has more favorable short-term outcomes with a shorter procedure duration, less blood loss and no implant failures.

Evaluation of the Functional and Clinical Outcome of Intramedullary Osteosynthesis with Gamma Nail in Treatment of Unstable Peritrochanteric Fractures

AbstractBackground: Peritrochanteric fractures of the femur rank among the most common fractures in elderly people. The Gamma Nail is one of the latest advances in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures.Purpose: This paper is made to assess the Functional & clinical Outcome of closed intramedullary osteosynthesis with a gamma nail in the treatment of unstable peritrochanteric fractures.Material and Methods: The study was based on a total of 30 patients surgically treated for unstable peritrochanteric femoral fracture by gamma nail fixation in the period between June/2012 till February/2014, including 10 males and 20 females with the mean age is 67.63 (range 50 to 81). The right side was affected in 16 patients and left side was affected in 14.Results: There were 28 patients (93.33%) with good reductions while there was 2 cases with mild displacement (<8mm) in both AP & lateral views but considered accepted. The fracture had healed in all the patients with no significant varus displacement except in 2 patients where their fracture had healed with mild (<20) degrees varus angulations. No intraoperative complication were reported. Post operative fracture of femur midshaft had occurred in 1 patient after 10 weeks. Screw cutout had occurred also in 1 case while 3 cases sustained suerficial infection. Recovery situations of all patients were evaluated based on Harris scoring with an average of 87 points. There are indications and improved functional outcome in the treatment of unstable intertrochanter-ic fracture with Gamma 3 intramedullary nail.Conclusion: Various studies found favorable results with gamma nail in managing a greater variety of unstable hip fractures with a less invasive technique and with better results. Other studies have reported favorable results with GN in terms of shorter operation time, less blood loss, shorter hospital stay, decreased wound infection and reduced complication rate.

Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures

IntroductionComparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF). MethodsEvaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS). ResultsA statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001). ConclusionThe new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.

A comparative study of treatment of unstable intertrochanteric fractures with PFN and cemented hemiarthroplasty

Aim: Aim of the study is to analyse and compare the functional outcomes and radiological results of two different surgical modalities, PFN and cemented hemiarthroplasty in the treatment of unstable intertrochanteric fractures in elderly patients. Background: Elderly patients with intertrochanteric fractures should be mobilized early to reduce the morbidity and mortality. While cemented hemiarthroplasty allows early weight bearing, the prolonged surgical time increase the blood loss and mortality, whereas with PFN once the fracture becomes stable allows early mobilization thus overcoming the problems of recumbency. PFN efficiently preserves the femoral head and the abductor mechanism and thus has the biomechanical advantage of increased range of hip joint movements and better functional outcome. Materials and methods: Sixty patients of age 60 years and above with comminuted intertrochanteric fractures treated by PFN or cemented hemiarthroplasty were taken up for the prospective study in our institute between january2013 and june 2015. 30 patients underwent PFN and 30 patients had hemiarthroplasty. Average period of follow up was 2 years. Post-operative complications and mortality rates were compared between the two groups. Functional results and the hip range of movements were assessed by Harris Hip Score (HHS). In the mean follow up period of 22months radiological examination was done to assess the results & complications. Results: The demographic and background data of the patients in the two groups are statistically similar. At 2 years follow up PFN group patients had a mean HHS of 85.89 and HA group had 78.11. Pain, severity and range of hip movements are better in PFN group than HA group. Radiologicaly 4 patients in HA group had stem loosening and 2 patients had screw cut out in the PFN group with subsequent pain in the final follow up. Conclusion: PFN is a better option for the treatment of elderly intertrochanteric fractures as the operative time is short, easier surgical procedure & has less mortality. PFN also gives a better functional outcome in the late follow up than hemiarthoplasty.

Role of Proximal Femoral Nail in the Treatment of Unstable Intertrochanteric Fractures

Role of Proximal Femoral Nail in the Treatment of Unstable Intertrochanteric Fractures

Study of effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly

Background: Osteosynthesis of unstable intertrochanteric (IT) fractures in geriatric population needs prolonged bed rest to prevent implant failure, which in turn results in complications such as pressure sore and pulmonary infection. In literature, a newer approach, such as prosthetic replacement for unstable intertrochanteric fractures, has been described to allow earlier restoration of postoperative weight bearing. Our study aimed to evaluate the effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly. Materials and Methods: Forty-two elderly patients with unstable IT femur fractures were included in this study, of which 21 patients underwent coxofemoral bypass with remaining 21 patients treated with proximal femoral nail. Both the groups were comparable with regard to demographic data and injury variables. The clinicoradiological evaluation was done at regular follow-up visits at 6 weeks, 3 months, and 6 months postoperatively. The functional outcome between the two techniques was evaluated using Harris hip score. Results: The complications such as pressure sore and pulmonary infection were higher in proximal femoral nail group compared to coxofemoral bypass group. There was statistically significant difference in functional outcome between two groups at the end of 6 weeks (P = 0.048) but not significant at the end of 6 months (P = 0.357, better in coxofemoral bypass group). Conclusion: Coxofemoral bypass is a better option than proximal femoral nail in the treatment of unstable IT fractures in the elderly as it provides stable, pain-free, mobile joint with earlier restoration of walking ability, less complications, and good functional outcome.

Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis.

PurposeThis study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies.Materials and MethodsSystematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types.ResultsThere were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03).ConclusionCemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.

Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring.

PurposeBipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture.Materials and MethodsWe reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem.ResultsSixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive.ConclusionCerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.

Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing

Backround: Intertrochanteric fractures in the elderly pose certain special problems and need to be addressed in a balanced way as on one hand senile osteoporosis requires prolonged immobilization, on the other hand rapid mobilization is required as they are generally medically compromised due to age and associated diseases. Despite several randomized trials and comparative studies treatment of unstable intertrochanteric fractures in elderly patients is still controversial, which we want to investigate in this set-up which caters to a vast rural population. Methods: A retrospective analysis of 54 patients, of which 27 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2012 till July 2016 was done. Primary outcome was assessed in both groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. All complications were noted at follow ups. Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 77.81 for BPA and 71.18 for PFN (p-value = 0.001) and at 1 year of follow up was 85.55 for BPA and 77.03 for PFN (p-value = 0.001). Statistically significant differences were found between BPA and PFN groups with reference to intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. Conclusion: The bipolar hemiarthroplasty group had fewer complications and earlier mobilization with better Harris hip score at all follow ups, which indicate bipolar hemiarthroplasty is a better option in the treatment of unstable intertrochanteric fractures in senile osteoporotic patients.

Effect of Implanting Prosthesis Combined with Internal Fixation for the Treatment of Unstable Intertrochanteric Fractures in the Elderly

Effect of Implanting Prosthesis Combined with Internal Fixation for the Treatment of Unstable Intertrochanteric Fractures in the Elderly