A study on functional outcome of cemented bipolar hemiarthroplasty and proximal femoral nailing for intertrochanteric fractures of femur in elderly patients 60-90 years
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251127Keywords:
Blood loss, Functional outcomes, Hemiarthroplasty, Intertrochanteric fracturesAbstract
Background: Intertrochanteric fractures are common in elderly patients, often resulting from low-energy falls and exacerbated by osteoporosis. Procedures like bipolar hemiarthroplasty (BHA) and proximal femoral nailing (PFN) present unique benefits and challenges. The aim of the study was to compare the functional outcome of intertrochanteric fracture treated with proximal femoral nail and cemented bipolar hemiarthroplasty.
Methods: A longitudinal observational study was conducted among patients with complaint of an intertrochanteric fracture between March 2021 and August 2022. A total of 24 patients were selected based on particular inclusion and exclusion criteria and divided into two groups of 12. After the respective procedure, patients were monitored for a duration of 5 months, both preoperatively and postoperatively at 1, 3, and 5 months. The collected data included demographic data, clinical data as well as Harris hip score which was then entered into excel sheets and then analyzed using EZR version 1.54 software.
Results: The present study included 24 patients of which 37.5% were males and 62.5% were females with a mean age of 78.17±9.13 years. The mean blood loss observed was 203.75±65.99 ml, mean surgery time was 96.42±26.02 minutes, and mean number of days needed to bear full weight was 28.21±20.42 days. Of the fracture patterns, 31-A2 was the most common encountered (54.2%). The mean amount of blood loss among participants in the PFN group was 152.50±24.17 ml and in the bipolar group the mean blood loss was 255±52.83 with this difference being statistically significant (p<0.05).
Conclusions: This study found significant intraoperative blood loss differences between PFN and CBH in older intertrochanteric fracture patients. The statistically significant reduction in blood loss makes PFN a safer surgery for this sensitive group.
Metrics
References
Li XP, Zhang P, Zhu SW, Yang MH, Wu XB, Jiang XY. All-cause mortality risk in aged femoral intertrochanteric fracture patients. J Orthop Surg Res. 2021;16(1):727. DOI: https://doi.org/10.1186/s13018-021-02874-9
Fischer H, Maleitzke T, Eder C, Ahmad S, Stöckle U, Braun KF. Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res. 2021;26(1):86. DOI: https://doi.org/10.1186/s40001-021-00556-0
Martinho T, Stoffel K. Treatment of intertrochanteric femur fractures with hip arthroplasty in older patients: a narrative review of indications and outcomes. Medicina. 2021;57(8):763. DOI: https://doi.org/10.3390/medicina57080763
Bhakat U, Bandyopadhayay R. Comparitive study between proximal femoral nailing and dynamic hip screw in intertrochanteric fracture of femur. Open J Orthoped. 2013;3:291-5. DOI: https://doi.org/10.4236/ojo.2013.37053
Aithala PJ, Rao S. Proximal femoral nailing: technical difficulties and results in trochanteric fractures. Open J Orthoped. 2013;3:234-42. DOI: https://doi.org/10.4236/ojo.2013.35044
Nho JH, Seo GW, Kang TW, Jang BW, Park JS, Suh YS. Bipolar hemiarthroplasty in unstable intertrochanteric fractures with an effective wiring technique. Hip Pelvis. 2023;35(2):99-107. DOI: https://doi.org/10.5371/hp.2023.35.2.99
Liu L, Sun Y, Wang L, Gao Q, Li A, Wang J, et al. Total hip arthroplasty for intertrochanteric fracture fixation failure. Euro J Med Res. 2019;24:39. DOI: https://doi.org/10.1186/s40001-019-0398-1
Hassankhani EG, Omidi-Kashani F, Hajitaghi H, Hassankhani GG. How to treat the complex unstable intertrochanteric fractures in elderly patients? DHS or arthroplasty. Arch Bone Jt Surg 2014;2(3):174-9.
XXX.
Camurcu Y, Cobden A, Sofu H, Saklavci N, Kis M. What are the determinants of mortality after cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients? J Arthroplast. 2017;32(10):3038-43. DOI: https://doi.org/10.1016/j.arth.2017.04.042
Mansukhani SA, Tuteja SV, Kasodekar VB, Mukhi SR. A comparative study of the dynamic hip screw, the cemented bipolar hemiarthroplasty and the proximal femoral nail for the treatment of unstable intertrochanteric fractures. J Clin Diagn Res. 2017;11(4):RC14-9. DOI: https://doi.org/10.7860/JCDR/2017/21435.9753
Singh J, Kumar D, Kumar S, Mittal A, Gupta PK, Rajput AK, et al. Functional outcome of hemiarthroplasty of the hip for unstable intertrochanteric fractures of the femur in elderly patients: a prospective study. Cureus. 2022;14(12):e32526. DOI: https://doi.org/10.7759/cureus.32526
Elhadi AS, Abdelgadir AH, Elbushra EM, Gashi YN. Outcome of primary cemented bipolar hemiarthroplasty in older patients with unstable hip fracture: A prospective study. J Musculoskelet Surg Res. 2019;3:196-9. DOI: https://doi.org/10.4103/jmsr.jmsr_54_18
Sancheti KH, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop. 2010;44(4):428-34. DOI: https://doi.org/10.4103/0019-5413.67122
Patil V, Nandi SS, Naik S, Vinaykumar B, Kulkarni S, Patel RK. Functional outcome of unstable comminuted intertrochanteric fractures in elderly treated with primary bipolar hemiarthroplasty. Int J Orthop Sci. 2019;5:59-62. DOI: https://doi.org/10.22271/ortho.2019.v5.i1b.13
Shukla R, Singh M, Jain RK, Mahajan P, Kumar R. Functional outcome of bipolar prosthesis versus total hip replacement in the treatment of femoral neck fracture in elderly patients. Malays Orthop J. 2017;11(1):1-5. DOI: https://doi.org/10.5704/MOJ.1703.002
Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018;19(1):1-8. DOI: https://doi.org/10.1186/s12891-018-2276-3
Ibrahim YB, Mohamed AY, Ibrahim HS, Mohamed AH, Cici H, Mohamed YG, et al. Risk factors, classification, and operative choices of femur fractures at a tertiary hospital: first report from Somalia. Sci Rep 2023;13:12847. DOI: https://doi.org/10.1038/s41598-023-39671-9
Roy S, Moaiyadi A, Salunkhe P, Vaidya SP, Warade N, Badole CM. A comparative study evaluating the outcomes of primary cemented bipolar hemiarthroplasty versus proximal femoral nail osteosynthesis for unstable intertrochanteric femur fractures in the elderly patient. J Orthop Case Rep. 2024;14(11):225-31. DOI: https://doi.org/10.13107/jocr.2024.v14.i11.4976
Pradeep C, Anuj A, Abhishek G, Treatment of comminuted unstable inter-trochanteric fracture in elderly patients with cemented bipolar prosthesis. Indian J Orthop Surg. 2015;1(4):255-60. DOI: https://doi.org/10.5958/2395-1362.2015.00038.9
Guo J, Wang Z, Fu M, Di J, Zha J, Liu J, et al. Super elderly patients with intertrochanteric fractures do not predict worse outcomes and higher mortality than elderly patients: a propensity score matched analysis. Aging. 2020;12(13):13583-93. DOI: https://doi.org/10.18632/aging.103466
Cai C, Tian L, Chen Z, Sun P, Wang G. Cementless bipolar hemiarthroplasty compared with proximal femoral nail anti-rotation of unstable intertrochanteric fractures in senile patients with osteoporosis: a retrospective study. BMC Musculoskelet Disord. 2022;23:461. DOI: https://doi.org/10.1186/s12891-022-05426-2
Yang L, Yang H, Chen Q, Shen H, Wang Z. Analysis of risk factors for 90-day mortality after surgery in elderly patients with intertrochanteric fractures and a history of cardiovascular disease. Ann Palliat Med. 2022;11(1):155-62. DOI: https://doi.org/10.21037/apm-21-3625
Tang Z, Wu Q, Li P, Wei X. Bilateral intertrochanteric fractures in an elderly patient following high-energy trauma: a case report. BMC Musculoskelet Disord. 2024;25:310. DOI: https://doi.org/10.1186/s12891-024-07432-y
Downloads
Published
How to Cite
Issue
Section
