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Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry

  • Orthopaedic Surgery
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Abstract

Introduction

The treatment of unstable intertrochanteric fracture in elderly patients is challenging and how to treat these patients remains controversial. The purposes of this study were to compare (1) reoperation rate, (2) mortality and (3) the postoperative change of walking ability between patients undergoing internal fixation (IF) and those undergoing bipolar hemiarthroplasty (HA) due to this type of fracture based on the data from the Korean Hip Fracture Registry.

Materials and methods

Between July 2014 and June 2016, we extracted 623 unstable intertrochanteric fractures (616 patients aged ≥ 65 years) according to the classification of the Association for the Study of Internal Fixation-American Orthopaedic Trauma Association. Among the 564 patients, 396 were treated with IF (IF group) and 168 with bipolar HA (HA group). We compared the reoperation rate and mortality between IF group and HA group. In patients, who were followed up more than 2 years after the surgery, we compared the postoperative change of walking activity from ambulatory outdoors (Koval’s grade 1, 2, 3) to housebound (Koval’s grade 4, 5, 6).

Results

The rate of reoperation was higher in the IF group (24/396, 6.1%) than in the HA (4/168, 2.4%) (p = 0.046). At the final follow-up, 79 (35.7%) of the 221 IF patients became housebound, whereas 21 (23.3%) of the 90 HA patients became housebound (p = 0.022).

Conclusion

This study showed HA was associated with lower rate of reoperation and lower decrement rate of walking ability compared to IF in elderly patients with unstable intertrochanteric fractures.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea

    Jin-Woo Kim

  2. Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, South Korea

    Hyun-Chul Shon

  3. Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang-si, South Korea

    Sang-Heon Song

  4. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Young-Kyun Lee & Kyung-Hoi Koo

  5. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea

    Yong-Chan Ha

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  1. Jin-Woo Kim
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Kim, JW., Shon, HC., Song, SH. et al. Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg 140, 1611–1618 (2020). https://doi.org/10.1007/s00402-020-03345-2

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