Role of hemiarthroplasty in intertrochanteric fractures in elderly osteoporotic patients: a case series
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Management of intertrochanteric fractures in elderly osteoporotic patients continues to be a challenging problem for orthopedic surgeons. Cutting out of implant from the femoral head and varus malpositioning of fragments is often seen in such cases if early ambulation is allowed. Prolonged bed rest in elderly patients leads to higher risk of complications such as bed sores, pneumonia and deep vein thrombosis not uncommonly leading to fatal pulmonary embolism. The purpose of this case series study was to assess the role of hemiarthroplasty in the treatment of intertrochanteric fractures in elderly patients and study the complications.
Materials and methods
Twenty-five patients were treated at a tertiary care center with hip hemiarthroplasty in intertrochanteric fractures. Mean age of the patients in the study was 77.8 years. Young patients with stable fractures and patients with active infection were excluded from study. Seventy-two percent of patients in the study were osteoporotic and associated comorbidity was present in 18 patients. Preoperative ambulatory status of all patients was noted for comparison. If calcar was deficient, calcar was reconstructed with a cut autograft from the femoral neck.
All Patients were followed for 1 year and evaluated using Modified Harris Hip Score except one patient who expired in postoperative period probably due to embolism. He had poor cardiopulmonary reserve preoperatively and cement was used in this case. Average period of initiation of full weight bearing in the present study was 5.5 days. Excellent/good results were seen in 20 patients (80%). One of the patients, who remained bedridden even after surgery, developed decubitus ulcer on the back and was labeled as failure. This patient expired 9 months after surgery. Dislocation of prosthesis was not seen in any case. One patient had shortening more than 1.5 cm due to sinking of prosthesis.
Although majority of patients with intertrochanteric fractures can be successfully managed with osteosynthesis, older patients with severe osteoporosis and associated comorbidity may benefit from prosthetic replacement. However, large scale studies are required to prove it conclusively.
KeywordsHemiarthroplasty Intertrochanteric fractures Osteoporosis
- 2.Bridle SH, Patel AD, Bircher M, Calvert PT (1991) Fixation of intertrochanteric fractures of femur: a randomized prospective comparison of the Gamma nail and DHS. Br J Bone Joint Surg 73:330–334Google Scholar
- 3.Halder SC (1992) The Gamma nail for peritrochanteric fractures. Br J Bone Joint Surg 74B:340Google Scholar
- 4.Leung KS, Sow S, Sen WY, Hui PW (1992) Gamma nails and dynamic hip screws for peritrochanteric fractures. Br J Bone Joint Surg 74B:345Google Scholar
- 8.D’Arcy J, Devas M (1976) Treatment of fractures of femoral neck by replacement with Thompson prosthesis. J Bone Joint Surg 58-B:279–286Google Scholar
- 10.George Haidukenych J, Berry DJ (2003) Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg 85A:899–904Google Scholar
- 11.Dimon JH III, Hughston JC (1967) Major components of unstable trochanteric fractures. J Bone Joint Surg 49A:440–444Google Scholar
- 12.Sarmiento A (1975) Valgus osteotomy technique for unstable trochanteric fractures. In: Proceedings of third open scientific meeting of hip society. CV Mosby, St. Louis, 157–169Google Scholar
- 13.Ecker MLM, Joyce JJ, Kohe JE (1975) The treatment of trochanteric hip fractures, a compression screw fixation. J Bone Joint Surg 87A:23–27Google Scholar
- 15.Tronzo R (1974) Use of endoprosthesis for severly comminuted trochanteric fractures. Clin orthop North Am 5(4):679–682Google Scholar
- 16.Haentjens P et al (1989) Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. J Bone Joint Surg 71-A:1214Google Scholar
- 23.Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg 51A:737Google Scholar