Hip Pelvis.  2015 Sep;27(3):152-163. 10.5371/hp.2015.27.3.152.

A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients

• Park BJ
• Cho HM
• Min WB

• KMID: 2069145
• DOI: http://doi.org/10.5371/hp.2015.27.3.152

Abstract

PURPOSE
To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients.
MATERIALS AND METHODS
From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were > or =70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases).
RESULTS
Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation.
CONCLUSION
In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.

Keyword

Femur; Intertrochanteric fractures; Hemiarthroplasty; Intramedullary nailing

MeSH Terms

Aged*
Butylated Hydroxyanisole
Early Ambulation
Femoral Fractures*
Femur
Fracture Fixation, Intramedullary
Fracture Healing
Hemiarthroplasty*
Hip Fractures
Hospitalization
Humans
Medical Records
Reoperation
Retrospective Studies
Butylated Hydroxyanisole

Figure

• 

  Fig. 1 An 82-year old female patient. (A) Preoperative anteroposterior radiograph of a pertrochanteric hip fracture (AO/OTA type 31.A2). The lateral wall is not broken. (B) Before her operation, we found a lateral wall fracture and a postoperative radiograph shows a lateral wall fracture of the left hip. (C) Follow-up at 24 months showing the lateral wall is migrating proximally.

• 

  Fig. 2 An 85-year-old female patient. (A) Anteroposterior radiograph of a pertrochanteric hip fracture (AO/OTA type 31.A3). The lateral wall is broken. (B) Postoperative radiograph. (C) Follow-up at six-weeks showing a displaced lateral wall fragment. (D) Follow-up at 24 months showing stable fixation of the femoral stem and united lateral wall fragments.

• 

  Fig. 3 A 78-year-old male patient. (A) Preoperative anteroposterior (AP) radiograph of a pertrochanteric hip fracture (AO/OTA type 31.A3). The lateral wall is broken. (B) Postoperative radiograph. Reduction of the fracture fragments is insufficient. (C) AP radiograph shows that the fracture healed 8 months after surgery. (D) The intramedullary nail system was removed 24 months after surgery.

• 

  Fig. 4 An 81-years-old female patient. (A) Anteroposterior radiograph of a pertrochanteric hip fracture (AO/OTA type 31.A3). The lateral wall is broken. (B) Postoperative radiograph. (C) Follow-up at 24 months showing non-union of the fracture.

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