J Korean Fract Soc.  2009 Jul;22(3):138-144. 10.12671/jkfs.2009.22.3.138.

Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

• Park MS
• Jung WC
• Park H
• Hwang BY
• Lim YJ
• Jung MG
• Cho HM

• KMID: 2063901
• DOI: http://doi.org/10.12671/jkfs.2009.22.3.138

Abstract

PURPOSE: To perform comparative analysis between the results of internal fixation using compression hip screw and cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients.
MATERIALS AND METHODS
From January 2001 to October 2006, we reviewd 73 patients, who were treated surgically for unstable intertrochanteric fractures, with a minimum of 2 years follow up. The patient's age was older than 60 year old. The patients were divided into two groups and evaluated, retrospectively. One group was treated with cemented bipolar hemiarthroplasty (Group A, 34 cases), and the other group was treated with compression hip screw (Group B, 39 cases). We evaluated the amount of intraoperative bleeding, operative time, clinical results and complications between the two groups.
RESULTS
The amount of intraoperative bleeding and operative time were no statistically significant between the two groups. Group A showed a better result than Group B for clinical outcome using Johnson Daily Activity of Life. Complications in the group A were comprised of dislocation (1 case), nonunion of greater trochanter (1 case), infection (1 case) and loosening (1 case), and those in the group B were comprised of loss of fixation (8 cases) and infection (1 case).
CONCLUSION
We found that short-term outcomes of cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures were satisfactory. However, a longer-follow up period is necessary to clarify the efficacy of cemented bipolar hemiarthroplasty.

Keyword

Intertrochanteric fracture; Bipolar hemiarthroplasty; Compression hip screw

MeSH Terms

Aged
Dislocations
Femur
Follow-Up Studies
Hemiarthroplasty
Hemorrhage
Hip
Hip Fractures
Humans
Operative Time
Retrospective Studies

Figure

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  Fig. 1 A 78-year-old female with right intertrochanteric fracture of the femur with severe osteoporosis. (A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification. (B) Postoperative radiogragh shows bipolar hemiarthroplasty state augmented with circumferencial and tension band wiring. (C) Last follow-up radiogragh at postoperative 38 months shows stable fixation.

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  Fig. 2 A 74-year-old male with left intertrochanteric fracture of the femur. (A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification. (B) Immediate postoperative radiograph shows no restoration of medial cortex and fixation with compression hip screw. (C) Follow up of 5 months radiograph shows cut-out of compression hip screw. (D) The radiograph at 25 months postoperative after fixation shows healing of the fracture despite excessive cut-out of compression hip screw.

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