Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients

Sung-Hwan Kim; Soo-Won Lee; Gyu-Min Kong; Mid-Um JeaGal

doi:10.5371/jkhs.2012.24.1.45

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Kim, Lee, Kong, and JeaGal: Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2012; 24(1): 45-52.

Published online: 31 March 2012

DOI: https://doi.org/10.5371/jkhs.2012.24.1.45

Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients

Sung-Hwan Kim, MD, Soo-Won Lee, MD, Gyu-Min Kong, MD, Mid-Um JeaGal, MD

Department of Orthopedic Surgery, Sunlin Hospital, Pohang, Korea.

Address reprint request to Soo-Won Lee, MD. Department of Orthopedic Surgery, Sunlin Hospital, 69-7 Daesin-dong, Buk-gu, Pohang 791-704, Korea. TEL: +82-54-245-5162, FAX: +82-54-245-5345, issueone@dreamwiz.com

Received 21 October 2011 Revised 14 March 2012 Accepted 15 March 2012

Abstract

Purpose

This study was performed to compare the clinical results and complications of bipolar hemiarthroplasty and internal fixation using proximal femur nail antirotation (PFNA) for unstable elderly femoral intertrochanteric fractures.

Materials and Methods

From May 2008 to September 2010, 74 patients older than 65 years who underwent bipolar hemiarthroplasty(33 patients) or PFNA(41 patients) and followed for more than 1 year after surgery were enrolled in this study. The mean blood loss during operation, mean operation time, radiological results, clinical results, and complications were analyzed by the Student t-test and Chi-square test to compare the two groups.

Results

The volume of blood loss during the operation was statistically lesser in the PFNA group (P<0.05) and operation time was not statistically different between the two groups (p=0.73). The bipolar hemiarthroplasty group showed a statistically better outcome than the PFNA group in the beginning of weight bearing (p<0.05), the hospital stay (p<0.05). The degradations of Koval score and modified Harris hip score of the bipolar hemiarthroplasty group were statistically better than those of the PFNA group (p=0.03, p=0.02). The bipolar hemiarthroplasty group showed a statistically lower incidence of mechanical(9.1%, p=0.01) and general(12.1%, p=0.00) complications than the PFNA group.

Conclusion

In elderly patients, bipolar hemiarthroplasty is thought to be one of the effective treatments for unstable femoral intertrochanteric fracutures when considering complications and clinical outcomes.

Keywords: Femur, Unstable intertrochanteric fracture, Bipolar hemiarthroplasty, Proximal femur nail antirotation

Figures and Tables

Fig. 1

(A) Initial radiograph in 89 year-old woman shows unstable intertrochanteric fracture according to AO/OTA classification. (B) Immediate postoperative radiograph shows that bipolar hemiarthroplasty was done. (C) Radiograph at 12 months shows well maintained state.

Fig. 2

(A) Initial radiograph in 83 year-old woman shows unstable intertrochanteric fracture according to AO/OTA classification. (B) Immediate postoperative radiograph shows that fixation was done with PFNA. (C) Radiograph at 12 months shows the bone union at the fracture site.

Table 1

Demographic Characteristics between the Group A and B

^*: Student t-Test, ^†:Male, ^‡:Female, ^§: Chi-Square Test, ^∥:Bone Mineral Density, ^¶: American Society of Anesthesiologists

Table 2

Intraoperative Finding between the Group A and B

Table 3

Pre-fracture Koval Score between the Group A and B

Table 4

Means of Koval Score and Modified Harris Hip Score between the Group A and B

^*:Pre-Fracture, ^†:Follow Up, ^‡:Degradation Between Pre-Fracture and Last Follow-Up State, ^§:Modified Harris Hip Score

Table 5

Limp and Support of Modified Harris Hip Score between the Group A and B

^*: Pre-Fracture, ^†: Follow Up

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