Comparative study of PFN A2 vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures

Abstract

Introduction: Successful outcome in the treatment of intertrochanteric fracture in elderly lies in early mobilization of the patient so as to avoid the morbidity, complications and poor recovery. With the associated medical comorbidities and osteoporosis, presents a great challenge in selecting the surgical procedures in these patients. Even though the primary choice of surgery revolves around Osteosynthesis in these type of fractures, there is a conspiracy in the choice of implants for the fractures. Many surgeons have resorted to primary hemiarthroplasty in these fractures to avoid uncertainties and implant failures and able to allow full weight bearing walking after surgery. Off late PFNA2 nail have been preferably used to stabilize these fractures with relatively lesser complications and early mobilization of these patients. The purpose of this study is to compare the outcome of PFNA2 and hemiarthroplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA2 group and hemiarthroplasty group from May 2017 to August 2018 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and Harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and Orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthroplasty groups have better Harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA2 provide less morbidity to patients with early mobilisation and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture.

Outcomes of Osteosynthesis Versus Hemiarthroplasty in Elderly Patients With Arbeitsgemeinschaft Fur Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) 31A2 Hip Fractures

“…Another study done by Vuppala et al [6] reported similar results in which scores were calculated at the fourth and sixth-month follow-up, and significant results were found with scores being 80.55 and 83.25 in the hemiarthroplasty group and 68.89 and 72.47 in the osteosynthesis group, respectively. Venkatraman et al [14] reported similar results in their study in favor of the hemiarthroplasty group.…”

“…There was one episode of dislocation in this study in the hemiarthroplasty group (3.33%). Other studies in the literature reported similar results, with Prasad et al [2] reporting an incidence of 3.7% in the hemiarthroplasty group and Venkatraman et al [14] reporting a single incidence of dislocation (5%) in the hemiarthroplasty group. While other authors such as Gokay et al [5], Nadir et al [7], and Patil [13] did not encounter an incidence of dislocation in their studies.…”

“…They also reported an incidence of deep infection in the hemiarthroplasty group (3.7%). Venkatraman et al [14] reported two…”

Comparison of mortality rates and risk factors for mortality between proximal femoral nailing and bipolar hemiarthroplasty for hip fractures

“…In contrast, BHA requires no time for fracture union, has lower implant failure, and allows the patient to compress with full load postoperatively. 4,5 Previous studies have reported that in-hospital mortality rates following hip fracture surgery vary between 2.7% and 15%, while 1-year mortality rates vary between 11.5% and 58.3%. 6 Many factors affecting mortality and morbidity in patients operated for hip fracture exist, including age, comorbidities, operation duration, and surgical technique.…”