Turkish Journal of Geriatrics 2016 , Vol 19, Issue 1
Erbil AYDIN, Burhan KURTULUŞ, Bülent ÇELİK, Mehmet OKAN
Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Division of Orthopaedics and Traumatology, ANKARA Introduction: The management of intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality and difficulty in weight bearing. Various internal fixation devices can be used for this type of fractures, and primary arthroplasty is also an option for treatment. This retrospective study compares bipolar hemiarthroplasty (BHA) with proximal femoral nail (PFN) in ambulatory elderly patients, focusing on functional results and return to premorbid level of activity.

Materials and Method: The study included 136 patients who underwent operations to treat AO 31-A type intertrochanteric fractures. Patients who were not ambulatory before having fracture were excluded from the study. Of the 78 patients with 31-A1 fractures; 40 were treated with BHA, 33 were treated with PFN and 5 were treated with dynamic hip screw (DHS). Forty patients had 31-A2 type fractures; 24 were treated with BHA, 7 were treated with PFN, 5 were treated with DHS and 4 were treated with different plate-screw systems. Eighteen patients had 31-A3 type fractures; 2 were treated with BHA, 15 were treated with PFN, and 1 was treated with a plate-screw system. Patients with BHA (mean age 80.61 years; range 68-98 years) and PFN (mean age 77.59 years; range 58-94 years) were compared in the final evaluation if they had at least 1 year of follow up documented postoperatively.

Results: Total perioperative blood loss was significantly lower in patients treated with PFN (590 to 390 ml). Time to surgery (4.1 vs 3.9 days), postoperative weight bearing time (2 vs 2 days), and mortality rates (16.66 % vs 18.18%) did not differ between patients treated with BHA and PFN, respectively. Total complication rate (22.4 % vs 28.2 %) was lower, and the duration of surgery (52.8 vs 82.5 min), the time to return to the premorbid daily activity (6.2 vs 8.5 weeks), Harris score (85.8 vs 81.3) and Postel Merle D'Aubigne (PMA) score (14.1 vs 12.2) were significantly better with BHA .

Conclusion: Hemiarthroplasty is not associated with greater postoperative mortality compared with osteosynthesis, although the perioperative blood loss is significantly higher. However, the complication rates are lower and functional results are better; thus, hemiarthroplasty can safely be the first choice of treatment for the intertrochanteric fractures of ambulatory elderly patients. Keywords : Hip Fractures; Geriatrics; Hemiarthroplasty, Bone Nails; Fracture Fixation, Intramedullary