DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20193590

Primary modular straight stem cemented prosthetic replacement for unstable, comminuted intertrochanteric fracture in the elderly with severe osteoporosis

Manju G. Pillai

Abstract


Background: The increasing number of hip fractures in the elderly, with the subset of unstable, comminuted intertrochanteric hip fractures is extremely relevant as the treatment is hampered by unsuccessful fixations and high complication rates. Osteoporosis and fracture geometry are two factors responsible for the failure of fixation in such fractures, upon which the surgeon has no control. Hence newer methods of fixation or treatment have to be opted for. The objective of the study was to evaluate the functional outcome of primary modular cemented prosthetic replacement for unstable, osteoporotic intertrochanteric fractures in a selected group of patients.

Methods: A total of 34 patients with type II and type III unstable intertrochanteric fractures were treated with primary modular cemented bipolar prosthesis and followed up in Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla.

Results: After surgery 94.12% patients regained walking capacity. The functional outcome at the time of discharge was fair to excellent in 88.24% of cases. The complications were few and the major benefit was early ambulation of patients and return to pre-fracture level of activity.

Conclusions: Primary modular bipolar straight stem cemented prosthetic replacement is probably the best option for treatment in previously independently ambulant, elderly osteoporotic patients with unstable, comminuted intertrochanteric fracture of femur.


Keywords


Unstable, Comminuted, Intertrochanteric fracture, Osteoporosis, Modular cemented prosthesis

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References


reen S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop. 1987;224:169-70.

Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand 1980;51:803-10.

Vidal J, Allieu Y, Buscayret C, Paran M. Treatment of various cervico-trochanteric fractures in the very old by prosthesis ofupper end of femur. Acta Orthop Belg. 1976;42:25-30.

Stern MB, Angerman A. Comminuted intertrochanteric fracture treated by Leibach prosthesis. Clin Orthop. 1987;218:75-80.

Parker MJ, Palmar CR. A new mobility score for predicting mortality after hip fractures. J Bone Joint Surg. 1993;755:797-8.

Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand. 1980;51:803-10.

Damron TA, Sim FH. Operative Treatment for Metastatic Disease of the Pelvis and the Proximal End of Femur. J Bone Joint Surgery (American). 2000;82:114-26.

Chan KC, Gill GS Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000;371:206-215.

Dobbs RE, Parvizi J, Lewallen DG. Perioperative morbidity and 30-day mortality after intertrochanteric hip fractures treated by internal fixation or arthroplasty. J Arthroplasty. 2005;20:963-6.

Haidukewych GJ, Berry DJ Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am. 2003;85:899-904.

Haentjens P, Casteleyn PP, DeBoerk H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients: primary bipolar arthroplasty compared with ORIF. J Bone Joint Surg. 1989;71(8):1214-25.

Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertro-chanteric fracture of the femur in the elderly, osteoporotic patient: A review. informa healthcare. 2005,27:18-19:1167-80.

Clarke HD, Damron TA, Sim FH. Head and neck replacement endoprostheses for pathologic proximal femoral lesions. Clin Orthop. 1998;353:210-7.

Lane JM, Sculco TP, Zolan S. Treatment of pathological fractures of the hip by endoprosthetic replacement. J Bone Joint Surg. 1980;62:954-9.

Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip. Ann R Coll Surg Engl. 1994;76(5):327-9.