Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture
Journal Title: Malaysian Orthopaedic Journal - Year 2018, Vol 12, Issue 1
Abstract
Introduction: Although the treatment of choice for unstable intertrochanteric fractures in elderly patients has been internal fixation for a long time, several studies have shown mechanical and technical failures. Primary cemented bipolar (PCB) hemiarthroplasty has been proposed as an alternative with some advantages concerning earlier mobilization and minimal postoperative complications. Materials and Methods: This is a prospective cohort hospital-based study conducted at three tertiary hospitals over a period of two years. A total of 98 patients were enrolled in the study, 38 patients treated with Dynamic Hip Screw (DHS) and 60 patients treated with PCB hemiarthroplasty. Intraoperative events (e.g. duration of surgery and blood loss), hospital stay, weight bearing, Harris Hip score and post-operative complications were used as predictors of final outcome. Mean follow-up was 13.66±5.9 months in hemiarthroplasty group and 11.8±2.7 months at internal fixation group. Results: The two groups were comparable in age, sex, comorbidity, mode of trauma, and classification of fracture. Early mobilisation was significantly better in hemiarthroplasty (p<0.001) where 93.3% of patients started partial weight bearing on postoperative Day 1, while in the DHS group, 73.7% of patients started partial weight bearing after two weeks postoperatively. At the final follow-up, the mortality rate did not differ between the two groups, but general and mechanical complications were more common in the DHS group. The mean Harris Hip score was better in the hemiarthroplasty group (91.14 vs 74.11). Conclusion: Primary cemented bipolar hemiarthroplasty is a safe and valid option in treating unstable intertrochanteric fracture. Although it has been shown to have some advantages over DHS in certain circumstances, lack of randomization and difficulties in standardization of patients and treating surgeon raise a need for more studies with bigger sample size and proper randomization.
Authors and Affiliations
Gashi YN, Elhadi AS, Elbushra IM
Keywords
Related Articles
- EP ID EP352239
- DOI 10.5704/MOJ.1803.007
- Views 104
- Downloads 0
Polyethylene Wear Particle Induced Osteolysis in Total Hip Replacement
Total hip replacement has consistently been shown to be one of the most reliable and successful surgical procedures in orthopaedic surgery 1,2. However time, the longevity of total hip replacement implants may be limited...
Internal Fixation of Only the Distal End in a Bipolar Segmental Clavicle Fracture: A Case Report
Bipolar segmental clavicle fractures are simultaneous clavicle fractures of both proximal and distal ends. Few case reports describing these fractures have been published, and the management of these injuries have remain...
Extra-Osseous Osteochondroma of the Knee
A 39 year old male presented with complaints of ongoing pain and restricted movements of right knee joint for a period of 7 years. Plain radiographs showed a calcified mass in the popliteal fossa. Open excision and biops...
Bilateral Traumatic Fracture of Neck of Femur in a Child: A Case Report
Bilateral femoral neck fractures are rare in the pediatric age group, and only a few cases have been reported following major trauma in children. A 9-year old girl presented with bilateral femoral neck fractures followin...
A New Technique for Solving Tightrope Cutout during Acromioclavicular Joint Fixation: A Case Report
Acromioclavicular joint (ACJ) dissociation is one of the common injuries affecting adults. The stability of ACJ largely depends on the integrity of acromioclavicular ligament, coracoclavicular ligament, capsule, trapeziu...