A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients

Abstract

PurposeTo compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients.Materials and MethodsFrom January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases).ResultsEarly ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation.ConclusionIn the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

“…One of the included trials reported the Harris hip score at 6 months, while the remaining reported at 12 months. Park showed that there was no difference between the intramedullary nail and hip replacement until 12 months, yet scores were significantly better in intramedullary nail group when measured at 24 months after the surgery. In another perspective study, Ozkayin et al .…”

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

“…A total of 774 IF and 814 AR cases with ITFs in the elderly from 14 studies were included. Seven studies were from the Asia (China Chang,Shen,Tang,Yang , South Korea Kim,Kim,Park ), [25][26][27][28][29][30][31] 6 studies were from the Europe (Turkey Kayali, Görmeli, Desteli, Özkayın, Güven , France Bonnevialle ), [32][33][34][35][36][37] and 1 study was from Africa Gashi . 38 Among these eligible trials, the AR included hemiarthroplasty and total hip arthroplasty, the IF included intramedullary system (GN, PFN, PFNA, IN) and extramedullary system (CHS, DHS), which represented the commonly used implants in clinical practice.…”

“…Ten studies covered the operative time, [25][26][27]29,[30][31][32][33][34][35]38 but only the data from 8 studies, 25,26,29,30,[32][33][34][35] including 753 patients were eligible in the form of mean and standard deviation. High heterogeneity was present in these studies (Chi 2 =129.74; P<0.00001; I 2 =95%).…”

“…Blood loss was documented in 5 studies, 25,27,29,31,33 and 2 of them including 201 patients were eligible in the form of mean and standard deviation. 29,33 The result of xed-effect model showed that there was a signi cantly different in the blood loss between the two groups (SMD=-4.08; 95% CI=-4.58, -3.59; P<0.00001) with no heterogeneity (Chi 2 =0.20; P=0.65; I² = 0%) ( Fig.3).…”

“…Ten studies, [25][26][27]29,[30][31][32]35,37,38 on a total of 1212 patients, covered major method-related complications, which mainly included the dislocation, loosening, cut out, breakage, intra-operative fracture of femur, postoperative fracture of femur, nonunion, delayed union and malunion. The heterogeneity test showed a low level among these studies (Chi 2 =14.48, P=0.11, I 2 =38%) and xed-effect model was adopted.…”