Study to compare the results of osteosynthesis of unstable intertrochanteric femoral fractures in elderly osteoporotic patients versus coxafemoral bypass by cemented bipolar prosthesis

Abstract

Introduction:Intertrochanteric fractures constitute about 45% of all hip fractures. Dynamic hip screw and plate (DHS) and Proximal femoral nail are commonly used for osteosynthesis. However, there are many studies which prefer hemiarthroplasty, i.e. coxafemoral bypass with cemented bipolar prosthesis as they claim that it allows early mobilization and decreases the complications of osteosynthesis. Hence, we decided to carry out this study. Material and methods:The present study was a retrospective review of all unstable or comminuted intertrochanteric fractures in elderly (above age 65 years) patients who were operated with osteosynthesis with DHS and plate and those with cemented hemiarthroplasty with bipolar prosthesis at MIMER Medical College, Talegaon (D) between January 2009 to December 2016. Data was collected from inpatient hospital files and out-patient department follow up. Unstable fracture patterns were included in the study. Patients in group one were operated with osteosynthesis by dynamic hip screw and plate while those in group two were operated with coxafemoral bypass surgery with cemented bipolar prosthesis. Patients were followed up in out-patient department after discharge, clinically and radiologically Results: There were 54 patients in group one (osteosynthesis with DHS plate) and 48 patients in group two (coxafemoral bypass with bipolar prosthesis). There were 21 males out of these in group one and 14 males in group two. In our study, we got less pressure sores and incidence of deep vein thrombosis in group of patients who underwent coxafemoral bypass with cemented bipolar prosthesis. Also need for blood transfusion was less than DHS group. Also hospital stay was significantly less. Operative time was, however, significantly more in bipolar group. However, there were not significant differences in implant or prosthesis related failure, pulmonary complications, dislocations or mortality in both groups. Bipolar cemented prosthesis group has better Harris Hip Score. Conclusion: Cemented bipolar prosthesis gives better results in unstable intertrochanteric femur fractures as compared to osteosynthesis