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Indian Journal of Orthopaedics Surgery


“Treatment of Comminuted Unstable Inter-Trochanteric Fracture in Elderly Patients with Cemented Bipolar Prosthesis”


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Author Details: Choudhari Pradeep, Agrawal Anuj, Gurjar Abhishek

Volume : 1

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 255

Article End Page : 260


Abstract

Introduction: Unstable intertrochanteric fractures in osteoporotic bones are difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure in internal fixation, with dynamic hip screws or intramedullary nail has been found high, especially in osteoporotic bones. The weak and porotic bone tolerates screws poorly so cut out is the major problem in internal fixation. The aim of this study was to assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis.
Material and Methods: 25 patients (11 males and 14 females) above 65 years of age with unstable intertrochanteric fractures who underwent bipolar arthroplasty were prospectively evaluated. Transtrochanteric approach was used in all patients. Greater trochanter encirclage was done in all patients. Harris hip score was used for the clinical evaluation. The minimum follow up period was one year.
Results: In our study 25 cases were taken, which had a mean age 73.44 ± 7.11years. The mean Harris hip score at one year was 80.54 ± 19.74. Excellent to good results were obtained at one year in 17(68%) cases and fair in 4 (16%) cases, poor in 2 (8%). Death of two patients occurs due to age related factors. Mean hospital stay was 14.24 ± 10.46 days. There was one case of superficial infection and one case of dislocation which where managed conservatively. Mean hospital stay was 14.24 ± 10.46. Radiological follow-up showed no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis.
Conclusion: Cemented bipolar hemiarthroplasty through trans-trochanteric approach give good result in a majority of elderly patient with unstable intertrochanteric fracture. It has advantage of an early ambulation and less hospital stay, as compared to the internal fixation. Also, the patient rehabilitation is easy and fast and none of the patient required any revision surgery. But the follow up period in our study is not enough to make any clinical recommendations though it can serve as a critical analysis to stimulate future research. Further long term studies are required.