Abstract: Introduction: Intertrochanteric fracture is one of the most common factures in elderly and is a major reason for decreased quality of life and increased mortality. Functional outcome following treatment of intertrochanteric fractures with osteosynthesis is not always satisfactory especially in unstable fractures. In our study, we analyze the role and outcome of total hip replacement in complex osteoporotic intertrochanteric femoral fracture.
Materials and Methods: 15 patients with complex and unstable intertrochanteric fracture were studied prospectively. All co-morbidities, metabolic problems, bone quality was assessed preoperatively and excluded. Fractures of AO/OTA type 31-A2.2, A2.3, A3.1, A3.2 & A3.3 and Evans type III or IV were included. THR was done in all cases using standard procedure and postoperatively rehabilitation and gait trainiag was done. Patients were followed up at 6 weeks, 3 months, 6 months up to one year and then annually. The patiens were evaluated clinically and radiologically and Harris hip score (HHS) was recorded an functional outcome evaluated.
Results: 15 patients who were able to walk without support before the fracture were included in the study. The average time of surgery was 81 min (range 55–92 min) with an approximate blood loss of 400 ml (range 200–500 ml). The average preoperative Harris Hip Score was 23.66 which improved to 81.73 at 2 year follow up which was a significant improvement (p value =0.0076). At 6 months all patients were ambulatory. 2 patients had pain, and walked with walker while 13 others were painless. 2 patients had shortening of limb of about 1.2 cm average and were managed by a shoe raise. Over all 87% patients had good result with HHS of >80 while 13% cases had poor results.
Conclusion: Unstable intertrochanteric fractures are difficult to treat with osteosynthesis because of unsatisfactory prognosis. Total hip replacement in intertrochanteric fractures is a better option because of early mobilization, better ability to bear weight and good long term prognosis.
