Clin Orthop Surg.  2015 Dec;7(4):436-442. 10.4055/cios.2015.7.4.436.

Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly

• Celiktas M
• Togrul E
• Kose O

• KMID: 2360256
• DOI: http://doi.org/10.4055/cios.2015.7.4.436

Abstract

BACKGROUND
The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment.
METHODS
Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit.
RESULTS
The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed.
CONCLUSIONS
Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.

Keyword

Hemiarthroplasty; Hip fractures; Weight-bearing

MeSH Terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip/adverse effects/*methods
Female
Femur/pathology/radiography/surgery
Hemiarthroplasty/adverse effects/*methods
Hip/pathology/radiography/surgery
Hip Fractures/physiopathology/radiography/*surgery
Humans
Male
Pain Measurement
Postoperative Complications
Prospective Studies

Figure

• 

  Fig. 1 Pre- and postoperative anteroposterior radiographs of a 77-year-old female patient. (A) Preoperative radiograph of an unstable intertrochanteric fracture of the right hip with classification of AO/OTA type 31-A2. (B) Immediate postoperative radiograph. Calcar regional stability was achieved by compaction between the implant and femur without the need for extra fixation of the neck and trochanter minor. (C) Postoperative 4 months radiograph. There is trochanteric lysis due to distal press fit manner. (D) Postoperative 36 months radiograph showing well-fixed prosthesis and integrated trochanter minor and major.

• 

  Fig. 2 Pre- and postoperative anteroposterior radiographs of an 86-year-old female patient. (A) Preoperative radiograph showing an unstable intertrochanteric fracture of the left hip with classification of AO/OTA type 31-A3. (B) Immediate postoperative radiograph. After the prosthesis was inserted in a distal press-fit manner, trochanteric regional stability was achieved by binding both the trochanter major and minor. (C) Postoperative 24 months radiograph showing well-fixed prosthesis.

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