To assess the effectiveness of the two techniques (MIPPO & IMILN) & Compare outcome. Methods: This is a Prospective, Randomized control trial involving 52 cases of extra-articular proximal tibial fractures treated either with MIPPO or IMILN in the Department of Orthopaedics, IMS and SUM Hospital, Bhubaneswar during September 2017 to September 2019. Functional outcome was calculated with Lower extremity functional scale and Knee society score and final outcome with Johner Wruhs criteria.Results: Each group had 26 cases in them, cases were followed-up for an average duration of 11.9 months. 2 cases from MIPPO group and 4 from IMILN group lost follow up. The average time to radiological union in MIPPO group was 16.1 weeks and that in IMILN group was 16.9 weeks. IMILN group had a higher rate of mal-reduction (19.1%) than MIPPO (15.4%). anterior angulation of the proximal fragment was commonest. Superficial infection occurred in 8.3% cases of MIPPO group and 4.5% in IMILN group. Non-union occurred in 1 (4.2%) and 1 delayed union (4.2%) in MIPPO group. Non-union developed in 1 case in IMILN group (4.5%) and 2 cases of delayed union (9.1%). Implant irritation was seen in 2 of our cases (8.3%) in MIPPO group. Anterior knee pain was observed in 2 patients in IMILN group (9.1%). LEFS in MIPPO was 45.8% and IMILN was 40.9%. Final outcome showed excellent result in 50% and 45.4% in MIPPO and IMILN respectively. Conclusions: If principles of treatment are correctly followed, most of cases will have excellent result with either modality of treatment.

Unstable osteoporotic intertrochanteric fractures are common in the elderly population. Failure rate of as high as 56% have been noted with internal fixation of unstable fractures mainly due to inadequate purchase in the osteoporotic bone and early full weight bearing. Hemiarthroplasty is a frequently employed alternative as it gives stability and allows immediate full weight bearing. This study evaluates the role of primary cemented hemiarthroplasty in the treatment of unstable trochanteric fractures in elderly and physiologically elderly patients. 30 elderly patients who were above 60 years of age with unstable osteoporotic intertrochanteric fractures, who underwent cemented bipolar hemiarthroplasty were studied prospectively from July 2017-july 2019. Patients who were less than 60 years of age, non ambulatory before injury and patients with stable intertrochanteric fractures, pathological fractures cognitive impairment were excluded from the study. Fractures were classified based on Boyd and Griffin classification. All the patients were treated with cemented bipolar prosthesis through posterior (Moore's) approach. Mean follow up period was 12 months. Patients were assessed using modified Harris hip score. This study included 12 males and 18 female patients with mean age of 73. There were 24 patients with a byod and griffin type 2 injury and 6 patients sustained a byod and griffin tye 3 injury. The average intra operative blood loss was 357 ml and average operative time was 75 mins. On an average patients were allowed to bear full weight on 7 th post operative day. 2 patients had superficial infection and 1 patient had a shortening more than 2 cms. 9 patients had abductor weakness. There were no cases of prosthetic dislocation, periprosthetic fracture, acetabular erosion and stem loosening. Primary cemented hemiarthroplasty for unstable osteoporotic elderly trochanteric fractures appears to be a good alternative treatment modality. Early full weight bearing and rehabilitation is a definitive advantage of this method.