Injuries like intertrochanteric factures are a common problem in the elderly. The management of comminuted intertrochanteric fractures is challenging because of excessive collapse, cut out of the lag screw and loss of fixation. Present study has been undertaken to evaluate the functional outcome of comminuted intertrochanteric fractures treated with cemented bipolar hemiarthroplasty compared with dynamic hip screw fixation.
Objectives: To compare the results, efficacy in meeting the activities of daily routine, functional and clinical outcomes of cemented bipolar hemiarthroplasty and dynamic hip screw fixation as a treatment for comminuted intertrochanteric fractures in elderly patients.
Methodology: This prospective study was conducted on 32 cases of intertrochanteric fractures of hip, 16 cases treated with cemented bipolar hemiarthroplasty and 16 cases with dynamic hip screw fixation. The cases were classified according to AO:OTA classification. Hardinge’s modification of anterolateral approach was used for cemented bipolar cases and lateral approach was used for dynamic hip screw fixation. Preoperative care, intraoperative care, postoperative care and complications during follow up period were observed. Functional evaluation was done by using Harris hip score (HHS) and data was analysed.
Results: In the present study, age group range for patients was from 60 to 75 years. 56.17% were male & 43.75% were female. Harris hip score in cemented bipolar group showed 6(37.5%) excellent, 6 (37.5%) good, 4(25%) fair results while dynamic hip screw group showed 4(25%) excellent, 6(37.5%) good, 2(12.5%) fair and 4(25%) poor results. Complications noted in the study of cemented bipolar group were 1(6.25%) case of superficial wound infection, 4(25%) cases of shortening and 6(37.5%) cases of abductor weakness with Trendelenburg gait while complications in the dynamic hip screw group were 4(25%) cases of implant failure, 3(18.75%) cases of nonunion, 2(12.5%) cases of knee stiffness and 4 (25%) cases of varus angulation. 1(6.25%) patient died due to medical reasons. This study concludes that primary cemented bipolar hemiarthroplasty can be considered as one of the main treatment options in comminuted intertrochanteric fractures in elderly.