Hip Pelvis.  2015 Mar;27(1):30-35. 10.5371/hp.2015.27.1.30.

Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures

• Suh YS
• Nho JH
• Kim SM
• Hong S
• Choi HS
• Park JS

• KMID: 2156017
• DOI: http://doi.org/10.5371/hp.2015.27.1.30

Abstract

PURPOSE
In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23])
MATERIALS AND METHODS
We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening).
RESULTS
There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000).
CONCLUSION
There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH

Keyword

Intertrochanteric fracture; Bipolar hemiarthroplasty; Compression hip screw; Proximal femur nail antirotation

MeSH Terms

Arthroplasty
Classification
Extremities
Femur*
Fracture Healing
Hemiarthroplasty*
Hip Fractures*
Hip*
Humans
Retrospective Studies

Figure

• 

  Fig. 1 Radiologic outcome was evaluated by limb length discrepancy after adjusting difference of magnification. Shortening was checked from hip center to wiring area of lesser trochanter (or distal tip of lesser trochanter, if there was no wiring) in bipolar hemiarthroplasty. A: postoperative length, A': length of postoperative 1 year, B: postoperative stem length, B': the length of stem at postoperative 1 year.

• 

  Fig. 2 Radiologic shortening was checked from hip center to first proximal screw in compression hip screw. A: postoperative length, A': length of postoperative 1 year, B: postoperative plate length, B': the length of plate at postoperative 1 year.

• 

  Fig. 3 Radiologic shortening was checked from hip center to distal locking screw in proximal femur nail antirotation. A: postoperative length, A': length of postoperative 1 year, B: postoperative nail length, B': the length of nail at postoperative 1 year.

Reference

1. Carpentier K, Govaers K. Internal fixation of an intertrochanteric femoral fracture after Birmingham hip resurfacing arthroplasty. Acta Orthop Belg. 2012; 78:275–278.

2. Anglen JO, Weinstein JN. American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008; 90:700–707.

3. Kreder HJ. Principles and evidence: The optimal treatment of pertrochanteric hip fractures: Commentary on an article by Kjell Matre, MD, et al.: "TRIGEN INTERTAN intramedullary nail versus sliding hip screw. A prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up". J Bone Joint Surg Am. 2013; 95:e16(1-2).

4. Matre K, Vinje T, Havelin LI, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am. 2013; 95:200–208.

5. Swart E, Makhni EC, Macaulay W, Rosenwasser MP, Bozic KJ. Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures. J Bone Joint Surg Am. 2014; 96:1612–1620.

6. Lee YK, Yoon BH, Nho JH, Kim KC, Ha YC, Koo KH. National trends of surgical treatment for intertrochanteric fractures in Korea. J Korean Med Sci. 2013; 28:1407–1408.

7. Guo Q, Shen Y, Zong Z, et al. Percutaneous compression plate versus proximal femoral nail anti-rotation in treating elderly patients with intertrochanteric fractures: a prospective randomized study. J Orthop Sci. 2013; 18:977–986.

8. Shen J, Wang DL, Chen GX, et al. Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients. J Orthop Sci. 2012; 17:722–729.

9. Parker MJ, Bowers TR, Pryor GA. Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip: a randomised trial of 600 fractures. J Bone Joint Surg Br. 2012; 94:391–397.

10. Chen YT, Chen WM, Lee KS, Huang CK, Chiang CC, Chen TH. Diaphyseal locking hip arthroplasty for treatment of failed fixation of intertrochanteric hip fractures. J Arthroplasty. 2008; 23:241–246.

11. Lee YK, Ha YC, Chang BK, Kim KC, Kim TY, Koo KH. Cementless bipolar hemiarthroplasty using a hydroxyapatite -coated long stem for osteoporotic unstable intertrochanteric fractures. J Arthroplasty. 2011; 26:626–632.

12. Choy WS, Ahn JH, Ko JH, Kam BS, Lee DH. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Clin Orthop Surg. 2010; 2:221–226.

13. Maxwell C. Sensitivity and accuracy of the visual analogue scale: a psycho-physical classroom experiment. Br J Clin Pharmacol. 1978; 6:15–24.

14. Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994; 76:751–758.

15. Koval KJ, Aharonoff GB, Rosenberg AD, Bernstein RL, Zuckerman JD. Functional outcome after hip fracture. Effect of general versus regional anesthesia. Clin Orthop Relat Res. 1998; 348:37–41.

16. Nho JH, Lee YK, Kim HJ, Ha YC, Suh YS, Koo KH. Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg Br. 2012; 94:32–36.

17. Egol KA, Marcano AI, Lewis L, Tejwani NC, McLaurin TM, Davidovitch RI. Can the use of an evidence-based algorithm for the treatment of intertrochanteric fractures of the hip maintain quality at a reduced cost? Bone Joint J. 2014; 96:1192–1197.

18. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995; 77:1058–1064.

19. Kazemian GH, Manafi AR, Najafi F, Najafi MA. Treatment of intertrochanteric fractures in elderly highrisk patients: dynamic hip screw vs. external fixation. Injury. 2014; 45:568–572.

20. Lee YK, Chung CY, Park MS, Lee KM, Koo KH. Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis. Arch Orthop Trauma Surg. 2013; 133:961–968.

21. Cole PA, Bhandari M. What's new in orthopaedic trauma. J Bone Joint Surg Am. 2006; 88:2545–2561.

22. Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res. 2013; 99:377–383.

23. Chang Q, Liu S, Guan C, Yu F, Wu S, Jiang C. Bipolar hip arthroplasty. J Arthroplasty. 2011; 26:1455–1459.

24. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000; 371:206–215.

25. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res. 1980; 146:53–61.

26. Harrington P, Nihal A, Singhania AK, Howell FR. Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly. Injury. 2002; 33:23–28.