Comparative study of unstable intertrochanteric fracture treatment by trochanteric femoral nail versus hip hemiarthroplasty

Abstract

The management of unstable intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing and the need for early mobilization. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study to compare the results of trochanteric fixation nailing (TFN) and hip hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients. Out of 50 patients with unstable intertrochanteric fractures 25 patients were treated with primary cemented bipolar hemiarthroplasty and 25 were treated with trochanteric femoral nail. Follow up was done post operatively at 1 months, 3 months, 6 months. At each follow up visit patients were evaluated radiologically and clinically. Functional outcome was evaluated by Harris hip score. Out of 25 patients operated by hemiarthroplsty, 3 patients had excellent results and 12 patients had good results whereas 9 patients had fair and one patient had poor results. Out of 25 patients operated with TFN, one had excellent results and 8 patients had good results whereas 10 patients had fair and 6 had poor results. Two hemiarthroplasty patients and one TFN patient developed superficial infection whereas one dislocation was also observed in hemiarthroplasty patient. Screw cut out from head was seen in one TFN patient and one TFN patient also developed pulmonary embolism. The cornerstone of management of such fractures is early surgery, followed by mobilization. Hence Cemented bipolar hemiarthroplasty offers a modality of treatment that provides adequate fixation and early mobilization in these patients thus preventing postoperative complications such as pressure sores, chest infection and DVT, as compared to TFN where there was more chance of complication due to prolonged immobilization.

Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

“…The mean duration of hospital stay in PFNA was shorter than BH, also significant difference (p-value 0.006 al, which also found a significantly lower blood loss in the PFN group. 5 Harris hip score (HHS) at 12 months showed a higher percentage of excellent and good scores for PFN as compared to HAB but similar numbers for DHS. 6 Another study by Suh Y-S et al, showed application of PFNA, DHS and HAB in management of comminuted intertrochanteric fractures.…”

“…Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. 5 The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. Restoration of mobility depends on the quality of bone and the type of implant used.…”