Unstable Intertrochanteric Femur Fracture in Elderly Treated with Bipolar Hemiarthroplasty Versus Dynamic Hip Screw - A Prospective Comparative Study

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Authors

  • Sandeep Pangavane
     Professor and HOD, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra ,IN
  • Nikhil Challawar
     Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra ,IN
  • Ameya Kulkarni
     Post-Graduate Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra ,IN
  • Nimesh Nebhani
     Post-Graduate Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra ,IN
  • Nitish Agrawal
     Post-Graduate Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra ,IN
  • Bhalchandra Bhalerao
     Post-Graduate Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra ,IN

DOI:

https://doi.org/10.18311/mvpjms/2019/v6i2/18289

Keywords:

Dynamic Hip Screw, Primary Bipolar Hemiarthroplasty, Unstable Inter-trochanteric Fractures
Hemiarthroplasty

Abstract

Introduction: Intertrochanteric fractures are one of the most common fractures in elderly population and have a huge impact on the health care system of the society. Objectives: The objective of our study was to compare functional outcome and complication rates of bipolar hemiarthroplasty to dynamic hip screw which is a established procedure for unstable intertrochanteric fracture femur. Materials and Methods: The present study included 50 patients over the age of 55 years, 25 undergoing bipolar hemiarthroplasty and 25 undergoing dynamic hip screw for unstable intertrochanteric fracture femur and their functional outcomes were compared with Harris hip score. Results: We found that the average Harris hip score was better for the bipolar hemiarthroplasty group than for the dynamic hip screw group at 6 months. Conclusion: Bipolar hemiarthroplasty is an effective alternative to dynamic hip screw for unstable intertrochanteric fractures in elderly patients as it has a good function outcome and lower complication rate. A larger randomized control trial has to be conducted to arrive at a conclusion.

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Published

2020-05-07

Issue

Volume 6, Issue 2, July-December 2019

Section

Original Research Article

 

References

Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed.

Rockwood & Green's Fractures in Adults, 6th Edition.

Bartucci EJ, Gonzalez MH, Cooperman DR. The effect of adjunctive methylmethacrylate on failures of fixation and function in patients with intertrochanteric fractures and osteoporosis. J. Bone Joint Surg. Am. 1985; 67:1094–107. https://doi.org/10.2106/00004623-198567070-00014. PMid: 4030829.

Audige L, Hanson B, Swiontkowski MF. Implant-related complications in the treatment of unstable intertrochanteric fractures: Meta-analysis of dynamic screwplate versus dynamic screw-intramedullary nail devices. Int. Orthop. 2003; 27: 197-203. https://doi.org/10.1007/s00264-003-0457-6. PMid: 12734684, PMCid: PMC3458474.

Im GI, Shin YW, Song YJ. Potentially unstable intertrochanteric fractures. J. Orthop. Trauma. 2005; 19:5-9.

Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int. Orthop. 2002; 26:233–37. https://doi.org/10.1007/s00264002-0358-0. PMid: 12185526, PMCid: PMC3620945.

Hernigou P, Poignard A, Mathieu G, Cohen G, Manicom O, Filippini P. Total hip arthroplasty after failure of per- and subtrochanteric fracture fixation in elderly subjects. (French). Rev. Chir. Orthop. 2006;92. https://doi.org/10.1016/S0035-1040(06)75760-9.

Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with surgeon assessment. The Journal of arthroplasty. 2001 Aug 31; 16(5):575–80. https://doi.org/10.1054/arth.2001.23716. PMid: 11503116.

Kenzora JE, Mccarthy RE, J Drennan LO, Sledge CB. Hip fracture mortality: Relation to age, treatment, preoperative illness, time of surgery, and complications. Clinical Orthopaedics and Related Research. 1984 Jun 1; 186:45–56. https://doi.org/10.1097/00003086-198406000-00008.

Gordon PC. The probability of death following a fracture of the hip. Canadian Medical Association Journal. 1971 Jul 10; 105(1):47.

Kyle RF, Cabanela ME, Russell TA, Swiontkowski MF, Winquist RA, Zuckerman JD, Schmidt AH, Koval KJ. Fractures of the Proximal Part of the Femur. Instr. Course Lect. 1995; 44:227–53.

Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg. Am. 2001;83:643–50 https://doi.org/10.2106/00004623-200105000-00001. PMid: 11379732.

Wolfgang GL, Bryant MH, O'neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin. Orthop. 1982; 163:148–58. https://doi.org/10.1097/00003086-198203000-00022.

Liang YT, Tang PF, Gao YZ, Tao S, Zhang Q, Liang XD, Han G, Cui G, Yang MY. Clinical research of hemiprosthesis arthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. Zhonghua Yi Xue Za Zhi. 2005; 85(46):3260–62.

Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures Mechanical Failure After Internal Fixation. Bone and Joint Journal. 1990 Jan 1; 72(1):26–31. https://doi.org/10.1302/0301-620X.72B1.2298790.

Nordin S, Zulkifli O, Faisham WI. Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur. Medical Journal of Malaysia. 2002; 56:12–17.

Kaufer H, Matthews LS, Sonstegard D. Stable fixation of intertrochanteric fractures: A Biomechanical Evaluation. JBJS. 1974 Jul 1; 56(5):899-907. https://doi.org/10.2106/00004623-197456050-00002.

Levy RN, Siegel M, Sedlin ED, Siffert RS. Complications of ender pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip. J. Bone Joint Surg. 1983; 65(-A):66–69. https://doi.org/10.2106/00004623198365010-00009.

Liu M, Yang Z, Pei F, Huang F, Chen S, Xiang Z. A metaanalysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures. International Orthopaedics. 2010 Mar 1; 34(3):323–28. https://doi.org/10.1007/s00264009-0783-4. PMid: 19401825, PMCid: PMC2899291.

Saarenpää I, Heikkinen T, Ristiniemi J, Hyvönen P, Leppilahti J, Jalovaara P. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: A matched-pair study of 268 patients. International Orthopaedics. 2009 Feb 1; 33(1):255–60. https://doi.org/10.1007/s00264-007-0458-y. PMid: 17943284, PMCid: PMC2899252.

Simpson AH, Varty K, Dodd CA. Sliding hip screws: Modes of failure. Injury. 1989 Jul 1; 20(4):227–31. https://doi.org/10.1016/0020-1383(89)90120-4.

Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cutout failure in the treatment of peritrochanteric elderly hip fractures. International Orthopaedics. 2010 Jun 1; 34(5):719–22. https://doi.org/10.1007/s00264-009-0837-7. PMid: 19618186, PMCid: PMC2903170.

Wu CC, Shih CH, Lee MY, Tai CL. Biomechanical analysis of location of lag screw of a dynamic hip screw in treatment of unstable intertrochanteric fracture. Journal of Trauma and Acute Care Surgery. 1996 Oct 1; 41(4):699–702. https://doi.org/10.1097/00005373-199610000-00017. PMid: 8858031.

Wolfgang GL, Bryant MH, O'neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clinical Orthopaedics and Related Research. 1982 Mar 1; 163:148–58. https://doi.org/10.1097/00003086198203000-00022.

Johnson LL, Lottes JO, Arnot JP. The utilization of the Holt nail for proximal femoral fractures: A study of one hundred and forty-six patients. The Journal of Bone & Joint Surgery. 1968 Jan 1; 50(1):67–78. https://doi.org/10.2106/00004623196850010-00004. PMid: 5638119.

Broos PL, Rommens PM, Geens VR, Stappaerts KH. Pertrochanteric fractures in the elderly - Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution? Acta Chirurgica Belgica. 1991; 91(5):242–49. https://doi.org/10.1097/00005131199112000-00010. PMid: 1762006.

Claes H, Broos P, Stappaerts K. Pertrochanteric fractures in elderly patients: treatment with Ender's nails, blade-plate or endoprosthesis? Injury. 1985 Jan 1; 16(4):261–64. https://doi.org/10.1016/S0020-1383(85)80016-4.

Sinno K, Sakr M, Girard J, Khatib. The effectiveness of primary bipolararthroplasty in treatment of unstable intertrochanteric fractures in elderly patients. North Am. J. Med. Sci. 2010; 2:561–68. https://doi.org/10.4297/najms.2010.2561. PMid: 22558568, PMCid: PMC3338223.