Treatment of Unstable Intertrochanteric Fracture in Elderly Patients: Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

Myung-Sik Park; Woo-Chul Jung; Hyuk Park; Byung-Yun Hwang; Young-Jin Lim; Myung-Guk Jung; Hong-Man Cho

doi:10.12671/jkfs.2009.22.3.138

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Park, Jung, Park, Hwang, Lim, Jung, and Cho: Treatment of Unstable Intertrochanteric Fracture in Elderly Patients: Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

Original Article

Journal of the Korean Fracture Society 2009; 22(3): 138-144.

Published online: 31 July 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.3.138

Treatment of Unstable Intertrochanteric Fracture in Elderly Patients: Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

Myung-Sik Park, M.D., Woo-Chul Jung, M.D., Hyuk Park, M.D., Byung-Yun Hwang, M.D.^*, Young-Jin Lim, M.D.^*, Myung-Guk Jung, M.D.^*, Hong-Man Cho, M.D.^†

Department of Orthopedic Surgery, Medical School, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

^*Department of Orthopedic Surgery, Saint Carollo Hospital, Sunchon, Korea.

^†Department of Orthopedic Surgery, Daejeon Veterans Hospital, Daejeon, Korea.

Address reprint requests to: Young-Jin Lim, M.D. Department of Orthopedic Surgery, Saint Carollo Hospital, 1742, Jo-ray-dong, Sunchon 540-718, Korea. Tel: 82-61-720-2500, Fax: 82-61-720-6000, lyj2834@naver.com

Received 20 November 2008 Revised 27 May 2009 Accepted 24 June 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To perform comparative analysis between the results of internal fixation using compression hip screw and cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients.

Materials and Methods

From January 2001 to October 2006, we reviewd 73 patients, who were treated surgically for unstable intertrochanteric fractures, with a minimum of 2 years follow up. The patient's age was older than 60 year old. The patients were divided into two groups and evaluated, retrospectively. One group was treated with cemented bipolar hemiarthroplasty (Group A, 34 cases), and the other group was treated with compression hip screw (Group B, 39 cases). We evaluated the amount of intraoperative bleeding, operative time, clinical results and complications between the two groups.

Results

The amount of intraoperative bleeding and operative time were no statistically significant between the two groups. Group A showed a better result than Group B for clinical outcome using Johnson Daily Activity of Life. Complications in the group A were comprised of dislocation (1 case), nonunion of greater trochanter (1 case), infection (1 case) and loosening (1 case), and those in the group B were comprised of loss of fixation (8 cases) and infection (1 case).

Conclusion

We found that short-term outcomes of cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures were satisfactory. However, a longer-follow up period is necessary to clarify the efficacy of cemented bipolar hemiarthroplasty.

Keywords: Intertrochanteric fracture, Bipolar hemiarthroplasty, Compression hip screw

Figures and Tables

Fig. 1

A 78-year-old female with right intertrochanteric fracture of the femur with severe osteoporosis.

(A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification.

(B) Postoperative radiogragh shows bipolar hemiarthroplasty state augmented with circumferencial and tension band wiring.

(C) Last follow-up radiogragh at postoperative 38 months shows stable fixation.

Fig. 2

A 74-year-old male with left intertrochanteric fracture of the femur.

(A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification.

(B) Immediate postoperative radiograph shows no restoration of medial cortex and fixation with compression hip screw.

(C) Follow up of 5 months radiograph shows cut-out of compression hip screw.

(D) The radiograph at 25 months postoperative after fixation shows healing of the fracture despite excessive cut-out of compression hip screw.

Table 1

Demographic characteristics between the group A and B

I: Independant T-test, C: Chi-square test.

Table 2

Johnson daily activity of life (Johnson, J Bone Joint Surg Am, 1990)

Table 3

Clinical results

Chi-square test (p=0.01).

Table 4

Complications during follow-up period

Chi-square test (p=0.01).

References

1. Bonamo JJ, Accettola AB. Treatment of intertrochanteric fractures with a sliding nail plate. J Trauma. 1982; 22:205–215.

2. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fracture. Clin Orthop Relat Res. 2000; 371:206–215.

3. Donnelly WJ, Kobayashi A, Freeman MA, et al. Radiological and survival comparison of 4 methods of fixation of a proximal femoral stem. J Bone Joint Surg Br. 1997; 79:351–360.

4. Giliberty RP. A new concept of a bipolar endoprosthesis. Orthop Review. 1974; 3:40–45.

5. Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res. 1987; 224:169–177.

6. Haentjens P, Casteleyn PP, De Bocck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989; 71:1214–1225.

7. Holt EPJ. Hip fractures in the trochanteric region: treatment with a strong nail and early weight-bearing: a report of one hundred cases. J Bone Joint Surg Am. 1963; 45:687–705.

8. Hwang DS, Lee KJ, Choi JH. Recovery of walking ability after treatment of unstable intertrochanteric fractures in elderly patients-comparison of compression hip screw to primary hemiarthroplasty. J Korean Hip Soc. 1999; 11:22–29.

9. Jensen JS, Sonne-Holm S, Tondevold E. Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation. Acta Orthop Scand. 1980; 51:949–962.

10. Johnston RC, Fitzgerald RM, Harris WH, Poss R, Muller M, Sledge CB. Clinical and radiographic evaluation of total hip replacement: a standard system of terminology for reporting results. J Bone Joint Surg Am. 1990; 72:161–168.

11. Laros GS. Intertrochanteric fractures.The role of complications of fixation. Arch Surg. 1975; 110:37–40.

12. Massie WK. Extracapsular fractures of the hip treated by impaction using a sliding nail plate fixation. Clin Orthop. 1962; 22:180–202.

13. Paprota B, Krol R, Wiatrak A. Hip arthroplasty after failed internal fixation of the trochanteric fractures in aged patients with co-existent osteoporosis. Chir Narzadow Ruchu Ortop Pol. 2004; 69:85–89.

14. Stern MB, Goldstein TB. The use of the Leinbach prosthesis in intertrochanteric fractures of the hip. Clin Orthop Relat Res. 1977; 128:325–331.

15. Soreide O, Lillestol J, Alho A, Hvidsen K. Acetabular protrusion following endoprosthetic hip surgery: a multifactorial study. Acta Orthop Scand. 1980; 51:943–948.

16. Yoon HK, Cho DY, Shin DE, Kang SH. Comparision of functional recovery between internal fixation and hemiarthroplasty in basal intertrochanteric fracture in the over eighties. J Korean Orthop Assoc. 2004; 39:115–122.

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