Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures

Abstract

PurposeIn comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23])Materials and MethodsWe retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening).ResultsThere was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000).ConclusionThere were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH<PFNA<CHS).

Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis

“…There were 19 studies that used cemented stem, 14 that used cementless stem, and two comparative studies that used both stems. Eleven studies were prospective studies, which used methods with wires, cables, and sutures for fixation of fracture fragments 1 2 4 11 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42) .…”

“…A total of 18 comparative studies included an assessment of deep surgical site infection rates, of which eight used cemented stems 1 11 17 18 19 20 21 22) ; the remaining 10 used cementless stems 2 25 26 27 30 31 32 33 34 35) . There was low evidence of heterogeneity across the studies (I 2 =0%; P =0.999) leading to the use of a fixed model.…”

Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures

“…Radiologic shortening by stem subsidence could arise physiologically during fracture healing. 24 , 38 Munro et al reported that subsidence was observed in 24% of patients, although the majority of cases were less than 3 mm, and only 9% subsided more than 3 mm. 25 Mulay et al reported a mean subsidence of 5 mm (range, 2–10 mm) in 17 of 24 patients 48.…”

“…In this study, all cases achieved bony union without notable complications that would have required additional surgery, except 1 patient of refracture at the distal tip of plate. Radiologic shortening by stem subsidence could arise physiologically during fracture healing 24, 38. Munro et al reported that subsidence was observed in 24% of patients, although the majority of cases were less than 3 mm, and only 9% subsided more than 3 mm 25 .…”

Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture

“…The complex three-dimensional anatomy of bone dislocation is difficult to assess, which may lead to a prolonged period of traction reduction and radiation exposure ( 14 ). Furthermore, the severe displacement of ITF fragments may make closed reduction and internal fixation prone to varus/vague deformities ( 15 ).…”