Abstract: Background: The management of unstable osteoporotic intertrochantric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. The purpose of this study is to assess the mortality and morbidity and post-operative complication in high risk intertrochanteric fractures treated by cemented bipolar.
Material and Methods: We retrospectively studied, 28 elderly patients with preoperative ASA grade-III with unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV) by primary hemiarthroplasty using a cemented bipolar prosthesis. All patients were operated by the same surgical team. Bipolar implants were cemented (tapered design, 2nd generation cemented technique, standard length) and trochanteric comminution was circlage to restore abductor mechanism. The assessment was done with emphasis on perioperative mortality, morbidity and complications related to prolonged bed rest.
Results: Mean patient age was 75.6 (64-91) years and mean follow-up was 22.3 (5-48) months. 10 patients were able to walk with a walker in the first post-operative week. Rehabilitation was easier and faster and post op morbidity like pressure sore pulmonary complication was significantly low (P<0.05). The mortality (2/28) was significantly low. We obtained 15 excellent and 8 good results after 12 months according to the Harris hip-scoring system. The series thoroughly compared with standard international series like, Stern et al, Chris Grismud et al, Harwin et al, Haentgens et al, Chan et al, Green et al.
Conclusion: Primary Bipolar Hemiarthroplasty may be a better alternative treatment for unstable comminuted osteoporotic Intertrochanteric fractures in elderly moribund patients.
