Functional outcome of comminuted inter trochanteric fractures of femur treated using cemented bipolar hemiarthroplasty in elderly patients: A prospective study

Abstract

Introduction: The management of comminuted inter trochanteric fractures of femur in elderly patients is tricky as there is challenge of difficult anatomical reduction in osteoporotic bones, need for prolonged immobilization after surgery and more chances of screw cut out in poor quality bone. Prolonged immobilization will leads into complications like bed sores, chest infections, deep vein thrombosis, dependency and psycho social side effects, increasing the both morbidity and mortality. The aim of our study was to evaluate the functional outcome of cemented bipolar hemiarthroplasty in comminuted inter trochanteric fractures of femur in elderly patients using Harris Hip Score. Materials and Methods: This prospective study was conducted at Basaveshwara Teaching And General Hospital attached to M R Medical college, Kalaburagi. Twenty elderly patients with age above sixty years having comminuted inter trochanteric fractures of femur treated by using cemented bipolar hemi arthroplasty from june 2016 to may 2018 were evaluated for functional outcome using Harris Hip Score. Results: There were 12 female and 8 male patients with mean age of 71.29(60 -84) years treated by cemented bipolar hemiarthroplaty. The average surgery time was 96.34 min (64-125min), the average intraoperative blood loss was 355ml and average stay in hospital was for 14.5 days. Patients were followed up at 6 weeks, 3months, 6 month and 1 year. At one year follow up with help of Harris Hip Score 8 patients (40%) were graded as excellent, 10 patients (50%) as good and 2 patients (10%) as fair. Conclusion:The procedure offered rapid mobilization, early return to pre injury level and gave a lasting solution to elderly patients with comminuted inter trochanteric fractures of femur.

A comparative study of the results of unstable intertrochanteric fracture treated with cemented bipolar hemiarthroplasty with and without reconstruction of the greater trochanter

“…Intertrochanteric fractures unite readily due to broad fracture surfaces, adequate blood supply and they rarely lead to non-unions. If proper precautions are not taken fractures unite in malposition resulting in shortening, limp and restricted movements [6] . Intertrochanteric fractures are major cause of morbidity and mortality in the elderly.…”

“…Stable fractures can be easily treated with osteosynthesis with predictable results. However, the management of unstable intertrochantric (Evan's type III, IV, V and VI) fractures in elderly patients is a challenge because of difficulty in obtaining anatomical reduction and associated with high rates of morbidity and mortality, although the results have improved with the use of internal fixation [6] . Recent publications indicate concern with excessive sliding of these fixation devices when used in unstable intertrochanteric fractures which can result in unacceptable shortening and external rotation deformity of the limb.…”