Unstable intertrochanteric fracture in elderly patients: outcome of primary cemented bipolar hemiarthroplasty versus internal fixation

Abstract

TRAUMA Citation: Elhadi AS, Gashi YN. Unstable intertrochanteric fracture in elderly patients: outcome of primary cemented bipolar hemiarthroplasty versus internal fixation. SA Orthop J 2018;17(4):22-26. http://dx. AbstractBackground: The aim of this study was to evaluate the outcome of internal fixation in comparison with primary cemented bipolar (PCB) hemiarthroplasty in elderly patients with unstable intertrochanteric fracture. Methods:A prospective cohort multicentre study compared cemented bipolar (n=60) to osteosynthesis (n=57) in unstable intertrochanteric fracture (AO/OTA classification) in the elderly. Peri-operative mortality, complications and functional outcome were used as main outcome measures. Results:The two groups were comparable in age, sex, comorbidity, mode of trauma, and classification of fracture. In hemiarthroplasty, 93.3% of patients were able to start partial weight bearing on post-operative day 1, while in the internal fixation group, 75.4% of patients started partial weight bearing after two weeks post-operatively. At the final follow-up, one year after surgery, the mortality rate did not differ between the two groups, but general and mechanical complications were more common in the internal fixation group. The mean Harris Hip Score at final follow-up was better in the hemiarthroplasty group (91.14 vs 74.33). Conclusion:Primary cemented bipolar hemiarthroplasty was superior to internal fixation in terms of lower complication rates and better functional outcome. Level of evidence: Level 4

Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta‐Analysis

“…A total of 481 English language studies was preliminarily obtained from the database; 198 were duplicate articles and 259 articles were removed after reading the title or abstract. The full text of 24 articles was read and, finally, nine articles [9][10][11][12][13][14][15][16][17] were included in this study (Fig. 1).…”

“…Two reviewers independently used the Cochrane Collaboration tool for assessing risk bias or used the Newcastle-Ottawa scale (NOS) to assess the quality of the eligible studies: two randomized controlled trials 10,13 , one prospective cohort study 9 , and six retrospective studies 11,12,[14][15][16][17] . Risk of bias assessment of RCT was assessed using the Cochrane Collaboration tool.…”

“…Reoperation was compared for internal fixation and hemiarthroplasty. Six articles 9,10,12,13,15,16 mentioned reoperation. The results of the fixed effect model show that there is statistical heterogeneity among studies (P = 0.06, I 2 = 52%); the random effect model was then used for analysis.…”

“…The DVT for internal fixation and hemiarthroplasty were compared. Five articles 9,10,13,16,17 mentioned DVT. The results of the fixed effect model show that there was no statistical heterogeneity among studies (P = 0.41, I 2 = 0%).…”

Short-term effect of lengthened shank semi-hip replacement combined with wire ligation in the treatment of unstable intertrochanteric fracture of femur in elderly patients

“…For unstable intertrochanteric fracture of the femur in osteoporosis patients, the focus is not on reduction and xation, but on how to enable patients to obtain a well-functioning, stable, and painless hip joint as soon as possible [18], to enable patients to get out of bed as soon as possible, reduce various complications, improve quality of life and prolong lifetime. Although hip replacement is not the gold standard for the treatment of intertrochanteric fracture of the femur, it has a higher rate of excellent hip function after hip replacement [19], which is a better choice and an effective remedy for the failure of PFNA and other internal xation in the treatment of an intertrochanteric fracture. Some studies suggest that hip replacement with an extended shank is an important treatment method for intertrochanteric fracture of the femur, especially for patients with osteoporosis [20].…”