Short term results of modular bipolar hemiarthroplasty for the treatment of neglected trochanteric femur fracture in the elderly
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20195620Keywords:
Hemiarthroplasty, Fracture, Trochanter, ElderlyAbstract
Background: In rural India because of native practitioner culture people tend to neglect orthopaedic injuries and often present late to the hospitals. Bipolar hemiarthroplasty for neglected intertrochanteric fractures of the femur in the elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.
Methods: Sixteen patients with proximal extracapsular femoral fractures presented average 10.4 weeks late from the day of injury, were treated with modular bipolar hemiarthroplasty. There were 11 men and 5 women, with mean age of 72.8 years (range: 65–83 years). Primary cemented bipolar hemiarthroplasty was performed using the Hardinge lateral approach in a lateral decubitus position. Harris hip score was used for the clinical evaluation of the patients.
Results: Clinically, the Harris hip score at the last follow-up ranged from 92 to 59, with a mean value of 81.7. Postoperative radiographs showed a good position in all patients. 1 patient developed complication during cementing and 1 case came with dislocation. No case of infection, acetabular erosion, periprostheic fracture or implant loosening was reported in this study.
Conclusions: Primary cemented bipolar hemiarthroplasty is a good choice in elderly patients with neglected intertrochanteric fractures of the femur.
References
Rockwood PR, Horne JG, Cryer C. Hip fractures: A future epidemic? J Orthop Trauma. 1990;4:388–93.
Bergström U, Björnstig U, Stenlund H, Jonsson H, Svensson O. Fracture mechanisms and fracture pattern in men and women aged 50 years and older: A study of a 12-year population-based injury register. Osteoporos Int. 2008;19:1267–73.
Bannister GC, Gibson AG, Ackroyd CE, Newman JH. The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial. Clin Orthop Relat Res. 1990;254:242-6.
Chinoy MA, Parker MJ. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: A meta-analysis of 14 studies. Injury. 1999;30:157-63.
Flores LA, Harrington IJ, Heller M. The stability of intertrochanteric fractures treated w.ith a sliding screw-plate. J Bone Joint Surg Br. 1990;72:37-40.
Sernbo I, Fredin H. Changing methods of hip fracture osteosynthesis in Sweden. An epidemiological enquiry covering 46,900 cases. Acta Orthop Scand. 1993;64:173-4.
Bess RJ, Jolly SA. Comparison of compression hip screw and gamma nail for treatment of peritrochanteric fractures. J South Orthop Assoc. 1997;6:173-9.
Nordin S, Zulkifil O, Faisham WI. Mechanical failure of DHS fixation in intertochanteric fracture femur. Med J Malaysia. 2001;56:12–7.
Parker MJ, Handoll HH, Bhonsle S, Gillespie WJ. Condylocephalic nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2000;2:CD000338..
Larsson S, Friberg S, Hansson Li. Trochanteric fractures. Mobility, complications, and mortality in 607 cases treated with the sliding-screw technique. Clin Orthop Relat Res. 1990;260:232-41.
Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25:360-2.
Jensen JS, Tøndevold E, Mossing N. Unstable trochanteric fractures treated with the sliding screw-plate system. A biomechanical study of unstable trochanteric fractures. III. Acta Orthop Scand. 1978;49:392-7.
Hall LG. Comparison of nail-plate fixation Ender’s nailing for intertrochanteric fractures. J Bone Joint Surg. 1981;63:24–8.
Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br. 1992;74:340-4.
Srivastav S, Mittal V, Agarwal S. Total hip arthroplasty following failed fixation of proximal hip fractures. Indian J Orthop 2008;42:279-86.
Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res. 1987;224;169-77.
White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am. 1987;69:1335–40.
Wolfgang GL, Bryant MH, O’Neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop Relat Res. 1982;163:148–58.
Sernbo I, Johnell O, Gentz CF, Nilsson JA. Unstable intertrochanteric fractures of the hip: Treatment with Ender pins compared with a compression hip-screw. J Bone Joint Surg Am. 1988;70:1297–303.
Stern MB, Goldstein TB. The use of the Leinbach prosthesis in intertrochantric fractures of the hip. Clin Orthop Relat Res. 1977;128:325–3.
Haidukewych GJ, Berry DJ. Salvage of failed internal fixation of intertrochanteric hip fractures. Clin Orthop Relat Res. 2003;(412):184-8.
Cho CH, Yoon SH, Kim SY. Better functional outcome of salvage THA than bipolar hemiarthroplasty for failed intertrochanteric femur fracture fixation. Orthopedics. 2010;33:721.
Tronzo RG. The use of an endoprosthesis for severely comminuted trochanteric fractures. Orthop Clin North Am. 1974;5:679–81
Pho RW, Nather A, Tong GO, Korku CT. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient. J Trauma. 1981;21:792–7.
Harwin SF, Stern RE, Kulick RG. Primary Bateman-Leinbach bipolar prosthetic replacement of the hip in the treatment of unstable intertrochanteric fractures in the elderly. Orthopedics. 1990;13:1131–6.
Broos PL, Rommens PM, Deleyn PR, Geens VR, Stappaerts KH. Pertrochanteric fractures in the elderly: Are there indications for primary prosthetic replacement? J Orthop Trauma. 1991;5:446–51.
Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty. 2005;20:337–43.
Elmorsy A, Saied M, Allah AA, Zaied M, Hafez M. Primary bipolar arthroplasty in unstable intertrochanteric fractures in elderly. Open J Orthop. 2012;2:13–1.
Kumar GNK, Meena S, Kumar NV, Manjunath S, Raj MKV. Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: a prospective study. J Clin Diagn Res. 2013;7:1669–71.
Choy WS, Ahn JH, Ko JH, Kam BS, Lee DH. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Clin Orthop Surg. 2010;2:221–2.
Walia JPS, Sansanwal D, Walia SK, Singh S, Gupta AC. Role of primary bipolar arthroplasty or total hip arthroplasty for the treatment of intertrochanteric fracture femur in elderly. Pb J Orthop. 2011;12:5–9.
Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000;371:206–15.
Elmorsy A, Saied M, Allah AA, Zaied M, Hafez M. Primary bipolar arthroplasty in unstable intertrochanteric fractures in elderly. Open J Orthop. 2012;2:13–7.
