Bipolar Prosthetic Replacement for the Management of Unstable Intertrochanteric Hip Fractures in the Elderly Osteoporotic Patients

Choi, Choong Hyeok

Abstract

It has been known that the hemiarthroplasty of the hip with bipolar prosthesis is the one of primary treatment methods for management of unstable intertrochanteric hip fracture, especially in severe osteoprotic patients. Additionally this operative treatment allows early full weight bearing and has many merits for the patient to return to the preinjury functional level. But we think that this operative method has several considerable points for the more effective treatment technique in unstable osteoporotic intertrochanteric fractures. We review the nine interochanteric comminuted fractture patients treated with bipolar prostheses at the Department of Orthopedie Surgery of Ewha Womans University Mok-Dong Hospital from September, 1993 to June, 1994. The considered points are as follows: 1) The difficult problem is to judge the intraoperative head-neck length. which is reduced by the tension of the fascia between gluteus medius and vastus lateralis fascia, preoperative measuring the head-neck length with transparent template, level of the tip of greater trochanter and prosthetic femoral head, and range of motion of hip of greater trochanter and prosthetic femoral head, and range of motion of hip joint under the tr1al reduction. 2) The operative approach is the other considerable point for the exposure of medial cortical buttress and lesser trochanter in reducing and maintaining principal fragments, and for the accurate anteversion angle of femur. 3) Bipolar hemiathroplasty technique is not effective in reducing the operative time and the blood loss amount in operative field, wspecially in comminuted interochanteric fracture treatment.