A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing

Abstract

With the aging population, the incidence rate of osteoporosis has been rapidly increasing. [1] These fractures are predicted to reach 2.6 million in 2025 and 4.5 million in 2050 worldwide. [2] The incidence of these fractures, which frequently occur due to falls, is two-three times higher in females than in males. [3] Intertrochanteric fractures, which are usually unstable, can only be treated surgically. [4] The key point of the surgical treatment is stable fixation and early mobilization with full-weight bearing. However, this is not always as easy as it seems. Most of the patients are elderly, osteoporotic, with additional morbidity and limited mobilization, and prone to complications. [5,6] Therefore, there is no consensus regarding the treatment of Objectives: This study aims to compare the clinical and functional results of intertrochanteric femoral fractures treated with bipolar hemiarthroplasty (BHA) or proximal femoral nailing (PFN) in elderly patients. Patients and methods: This multicenter, prospectively followed-up, retrospectively compared cohort-type study included 308 patients (81 males, 227 females; mean age 78.4±7.2 years; range, 65 to 95 years) who were treated with BHA or PFN for intertrochanteric fractures by five orthopedic surgeons in four provinces and seven clinics between January 2014 and May 2018. Clinical follow-up was performed at third week, third and sixth months, and at the end of the first and second years. The American Society of Anesthesiologists for preoperative status, Singh index for bone quality, and Harris Hip Score (HHS) for functional outcomes were evaluated. Results: While 156 patients (38 males, 118 females; mean age 77.7±5.9) were treated with BHA, 152 patients (43 males, 109 females; mean age 79±6.1) were treated with PFN. While there was no significant difference between the two groups in terms of total HHS, a significant difference was found in the sub-parameters (p<0.001). Good and excellent results were found in 78.2% of BHA and 86.2% of PFN patients. Mortality rates were similar at the end of two years (14% and 13.6%, respectively). Conclusion: In general, clinical and functional outcomes of BHA and PFN are similar. The rates of pulmonary embolism and deep vein thrombosis are significantly higher in BHA. However, BHA is advantageous in terms of operation time and early weight bearing compared to PFN.

Should we operate on all patients with COVID-19 and proximal femoral fractures? An analysis of thirty, sixty, and ninety day mortality rates based on patients’ clinical presentation and comorbidity: a multicentric study in Northern Italy

“…However, statistical analysis revealed no significant difference. The same higher mortality rate for intramedullary fixation was observed by Ekinci et al [ 27 ], the study of Kim et al [ 28 ], and the meta-analysis of Ma et al [ 29 ]. Despite fracture types were different, all revealed a higher mortality rate for osteosynthesis in the first months from treatment, becoming similar after one or two years of follow-up, but no significant differences were found.…”

Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

“…Beyond this period, outcomes are inconsistent but tend to favor IM, although the reported differences are hardly ever statistically significant. It is assumed that preserving the native hip joint may contribute to this result [ 30 , 31 ].…”

Effect of Vertical and Lateral Offset Restoration on Clinical Outcomes in Intracapsular and Extracapsular Hip Fractures Undergoing Hemiarthroplasty

“…Strategies are being developed to improve surgical technique and fixation devices in these fragile patients with multiple comorbidities [4][5][6]. Hemiarthroplasty is an appropriate treatment option for selected patients as it provides early mobilization and good functional results in unstable intertrochanteric and femoral neck fractures [2,3,7,8].…”

“…Although studies in the literature have mainly focused on perioperative mortality and complications following hemiarthroplasty, the number of studies investigating the postoperative functional results has also been increasing in recent years [8][9][10]. There is current evidence to suggest that offset plays a role in patient pain and function following total hip arthroplasty (THA) [9][10][11][12][13].…”