Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note

Abstract

PurposeFemoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation.Materials and MethodsFrom September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability.ResultsLoosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases).ConclusionOur study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.

Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring

“…Our study presented that the cerclage fixation of the trochanter restored the abductor mechanism and the result of cementless bipolar HA using a grit-blasted long stem design was satisfactory in patients with unstable intertrochanteric fracture. The result of cerclage wiring was compatible with previous results of trochanteric fixation with wiring technique 24) .…”

“…Although restoration of abductor mechanism by wiring, weakening of walking ability is inevitable in elderly patients. Lee et al 24) reported 53.2% patients demonstrated a decrease of ambulatory capacity in patients treated by HA using various wiring techniques for trochanteric fixation. However, HA for unstable intertrochanteric fracture achieves better result in walking ability than internal fixation because HA facilitates early mobilization 25) .…”

“…Meanwhile, few articles were published about wiring technique for bipolar HA. Wiring techniques in previous studies and the present study are summarized in Table 2 7 8 9 16 24) . Strength of our technique is to preserve of abductor mechanism, because we did not detach soft tissue from fragment and wires were passed through insertion site of abductor muscle anteriorly and posteriorly.…”

Hip Arthroplasty Using the Bencox® Hip System: An Evaluation of a Consecutive Series of One Thousand Cases

“…Our previous 5-year follow-up study revealed good results of the Bencox® stem (e.g., excellent bone ongrowth rates [86.6% in the fracture group, 99.6% in the OA group without subsidence or complications requiring revision operation]) 19) . In another study, 78% of patients with an unstable intertrochanteric fracture experienced restoration of their ambulation ability to a pre-injury state, and the combined use of wiring fixation has been described to help obtain support in the posterolateral aspect including the lesser trochanter 5 10) . These results compare favorably to the long-term follow-up results of a study involving the Cementless Spotorno (CLS; Protek AG, Berne, Switzerland) stem and Zweymüller stem (Alloclassic; Sulzer Orthopedics, Basel, Switzerland) that resemble the tapered wedge design and blasted surface coating of the Bencox® hip stem.…”

“…Since the fracture line of the greater trochanter runs more in the coronal plane, reduction of bone fragments were performed after insertion of the femoral stem. Fragments were then fixed firmly using cables and wires to help achieve stability 10) .…”