Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Unstable Intertrochanteric Femoral Fracture in Elderly Patients

Abstract

Purpose: The purpose of this study is to evaluate the results of bipolar hemiarthroplasty using calcar replacement stem for comminuted intertrochanteric fracture in elderly patients. Materials and Methods: Between March 1998 and March 2008, the clinical records of 79 cases who were older than 75 years of age and underwent bipolar hemiarthroplaty, using calcar replacement stem with figure of eight and cerclage wiring, were reviewed. Their mean age was 82.4 years(75-92 years) and the mean follow-up period was 68 months(24-92 months). Results: The mean postoperative Harris hip score was 82.1(62-92), and preoperative walking ability was recovered in 56 cases(71%). Bony ingrowth fixation was achieved in 70 cases(89%), and fibrous stable fixation was in 9 cases(11%). Stress shields were revealed in 21 cases(27%). Nonunion of trochanter was found in 3 cases(4%), and wire fixation breakages were in 3 cases after bony union. The mean duration of bony union was 16.3 weeks(12-38 weeks). Aseptic loosening was observed in 1 case and protrusio acetabuli were in 2 cases. Conclusion:The result of clinical and radiological evaluations of bipolar hemiarthroplasty, using calcar replacement stem with figure of eight and cerclage wiring, were satisfactory in elderly patients with comminuted intertrochanteric fracture.

Treatment of Intertrochanteric Fractures Using the Compression Hip Nail

“…Intertrochanteric femoral fractures are very commonly observed, account for approximately half of all hip fractures 12) , and result in loss of independent living skills, as well as incomplete recovery of physical ability in approximately 50% of cases 13 , 14 , 15) . Several treatment options, such as compression hip screws, metal plates, and intramedullary nails are available, while replacement arthroplasty is performed only in limited cases 3 , 4 , 5 , 6) . These approaches represent various advantages and disadvantages, and therefore, a number of studies regarding their clinical outcomes have been reported 13) .…”

“…Compression hip screws have been widely utilized as treatments for intertrochanteric fractures; however, high fixation failure rates have been reported when they have been used to treat unstable fractures 1 , 2) . Therefore, intramedullary nailing has become a commonly used treatment option in recently years, while replacement arthroplasty has become increasingly reserved for limited cases 3 , 4 , 5 , 6) .…”

The Fixation Method according to the Fracture Type of the Greater Trochanter in Unstable Intertrochanteric Fractures Undergoing Arthroplasty

“…Nam et al9) have reported satisfactory results with cementless total hip arthroplasty and double tension band wiring in fixation of unstable intertrochanteric fractures with the greater trochanteric fragment. Moreover, Cho et al10) and Kho et al11) documented satisfactory results with hip hemiarthroplasty and cerclage wiring in fixation of unstable intertrochanteric fractures.…”