Failed intertrochanteric fracture managed with hemiarthroplasty: Guide on surgical technique

Abstract

Introduction: There have been many advances in internal fixation techniques to deal with poor quality of bone and severely comminuted intertrochanteric fractures so as to allow early ambulation. Failure rates with an internal fixation range between 3% and 12%. There have been a number of technical issues to convert these fractures into hip arthroplasty such as extraction of implants, bone deformity, bone loss, poor bone quality and associated trochanteric nonunion. Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Rate of failure with internal fixation, with dynamic hip screws and with nail has been found to be high, especially in osteoporotic bones. Weak purchase of the internal fixation device because of osteoporosis and comminution of the fracture increases the incidence of failure of internal fixation such as cutting out the screws and displacement of the bone fragments. Case summary: 75 years male previously operated with proximal femoral nail later had fall due to which implant failed, which were manged with implant removal with bipolar hemiarthroplasty. Conclusion:Management of intertrochanteric fractures depends on age, stability of fracture, bone density. Young patient with good bone density should managed with proximal femoral nail, but in older individuals with osteoporotic bone stock hemiarthroplasty is good option. As we cannot rely on internal fixation devices to allow early full weight bearing of patients in the presence of severe osteoporosis and marked comminution at the fracture site, partial weight bearing is very difficult to be followed by these patients; thus, they shift to full weight bearing on the operated limb, causing mechanical failure. Hemiarthroplasty using bipolar prostheses for the unstable intertrochanteric fractures of the femur in elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.