Prospective study of management of unstable intertrochantric femur fractures in elderly: hemiarthroplasty vs. osteosynthesis by proximal femoral nail

Authors

  • Kishor G. Murkute Department of Orthopaedics, PCMC’s Postgraduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India
  • Shivsagar V. Jadhav Department of Orthopaedics, PCMC’s Postgraduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India
  • Jeevan Tonde Department of Orthopaedics, PCMC’s Postgraduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India
  • Omprakash Kumar Badgujar Department of Orthopaedics, PCMC’s Postgraduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20223441

Keywords:

Unstable intertrochanteric femur fracture, Bipolar hemi-arthroplasty, Proximal femoral nail, Coxafemoral bypass technique

Abstract

Background: A prospective study was done to compare the outcomes of management of unstable intertrochantric femur fractures in elderly by hemiarthroplasty and osteosynthesis by proximal femoral nail.

Methods: This was an interventional prospective study. The study was carried out over 3 years from 2019 to 2022 at PCMC’s PGI YCMH, Pimpri, Pune, Maharashtra, India. The study was carried out over 3 years from 2019 to 2022;50 Patients were randomly divided into two groups; Group A (unstable intertrochanteric femur fracture patients treated by bipolar hemi-arthroplasty) and Group B (unstable intertrochanteric femur fracture patients treated by proximal femoral nailing) with 25 patients in each group. Outcomes were evaluated based on functional outcomes, mean surgical time, mean blood loss during surgery, post-operative length of stay, post-operative complications. Harris hip Score was used to assess clinical functional outcomes.

Results: The PFN group showed a better Harris Hip score at 1, 3, and 6 months follow ups. Mean surgical time was more in bipolar hemiarthroplasty group. Mean blood loss during surgery was more in bipolar hemiarthroplasty group. Post-operative length of stay was more in bipolar hemiarthroplasty group. Post-operative complications like infections, limb length discrepencies were more in bipolar hemiarthroplasty group, whereas 2 implant failures occurred in PFN group compared to a single one in bipolar hemiarthroplasty group.

Conclusions: Both PFN and bipolar-hemiarthroplasty appear to produce satisfactory outcomes in surgically treated unstable IT fractures, bipolar-hemiarthroplasty has the advantages of early mobilization and early weight bearing, no risk of non-union but PFN group is superior when it comes to functional outcomes, mean surgical time, Mean blood loss during surgery, post-operative length of stay, post-operative complications.

Author Biography

Kishor G. Murkute, Department of Orthopaedics, PCMC’s Postgraduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India

SENIOR RESIDENT IN DEPARTMENT OF ORTHOPAEDICS

References

Gill JB, Jensen L, Chin PC, Rafiei P, Reddy K, Schutt RC. Intertrochanteric hip fractures treated with the trochanteric fixation nail and sliding hip screw. J Surg Orthopaed Adv. 2007;16(2):62-6.

Tokgöz MA, Atik OŞ, Esendağlı G, Öğüt B, Bozkurt HH. Is it possible that the pathogenesis of osteoarthritis could start with subchondral trabecular bone loss like osteoporosis?. Joint Dis Related Surg. 2018;29(3):152-8.

Emami M, Manafi A, Hashemi B, Nemati A, Safari S. Comparison of intertrochanteric fracture fixation with dynamic hip screw and bipolar hemiarthroplasty techniques. Arch Bone Joint Surg. 2013;1(1):14.

Özkayın N, Okçu G, Aktuğlu K. Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: a prospective randomised clinical study. Injury. 2015;46:S3-8.

Paul O, Barker JU, Lane JM, Helfet DL, Lorich DG. Functional and radiographic outcomes of intertrochanteric hip fractures treated with calcar reduction, compression, and trochanteric entry nailing. J Orthopaed Trauma. 2012;26(3):148-54.

Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthopaed Res. 1987;1(224):169-77.

Patil A, Ansari M, Pathak A, Thakker CJ. Role of cemented bipolar hemiarthroplasty for comminuted inter-trochanteric femur fracture in elderly osteoporotic patients through a modified transtrochanteric approach “SION hospital modification”. IOSR J Dent Med Sci. 2013;9(4):40-7.

Yogi LK, Mahi G. A Comparative study of treatment of intertrochanteric fractures with bipolar prosthesis and proximal femoral nail in elderly. JMSCR. 2019;7(3):2455-9.

Ekinci Y, Gürbüz K, Batın S, Kahraman M, Doğar F, Erten ZK. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing. Joint Dis Related Surg. 2020;31(2):209.

Jin WJ, Dai LY, Cui YM, Zhou Q, Jiang LS, Lu H. Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons. Injury. 2005;36(7):858-61.

Gormeli G, Korkmaz MF, Gormeli CA, Adanas C, Karatas T, Simsek SA. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Turk J Trauma Emerg Surg. 2015;21(6):503-8.

Hari Prasad S, Patil SN, Sarath Chandra P, Cecil Fernando A. Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing. Int J Orthopaed Sci. 2017;3:319-23.

Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury. 2012;43(6):876-81.

Sonar UV, Ingle MV, Koichade MR, Yelne AB, Malu N. Comparative study between trochanteric fixation nailing and cemented bipolar hemiarthroplasty for the treatment of unstable osteoporotic intertrochanteric neck femur fractures in elderly patients. IOSR J Dent Med Sci. 2014;3:31-40.

Downloads

Published

2022-12-28

Issue

Section

Original Research Articles