Role of hemiarthroplasty in intertrochanteric fractures in elderly osteoporotic patients: a case series
Management of intertrochanteric fractures in elderly osteoporotic patients continues to be a challenging problem for orthopedic surgeons. Cutting out of implant from the femoral head and varus malpositioning of fragments is often seen in such cases if early ambulation is allowed. Prolonged bed rest in elderly patients leads to higher risk of complications such as bed sores, pneumonia and deep vein thrombosis not uncommonly leading to fatal pulmonary embolism. The purpose of this case series study was to assess the role of hemiarthroplasty in the treatment of intertrochanteric fractures in elderly patients and study the complications.
Materials and methods
Twenty-five patients were treated at a tertiary care center with hip hemiarthroplasty in intertrochanteric fractures. Mean age of the patients in the study was 77.8 years. Young patients with stable fractures and patients with active infection were excluded from study. Seventy-two percent of patients in the study were osteoporotic and associated comorbidity was present in 18 patients. Preoperative ambulatory status of all patients was noted for comparison. If calcar was deficient, calcar was reconstructed with a cut autograft from the femoral neck.
All Patients were followed for 1 year and evaluated using Modified Harris Hip Score except one patient who expired in postoperative period probably due to embolism. He had poor cardiopulmonary reserve preoperatively and cement was used in this case. Average period of initiation of full weight bearing in the present study was 5.5 days. Excellent/good results were seen in 20 patients (80%). One of the patients, who remained bedridden even after surgery, developed decubitus ulcer on the back and was labeled as failure. This patient expired 9 months after surgery. Dislocation of prosthesis was not seen in any case. One patient had shortening more than 1.5 cm due to sinking of prosthesis.
Although majority of patients with intertrochanteric fractures can be successfully managed with osteosynthesis, older patients with severe osteoporosis and associated comorbidity may benefit from prosthetic replacement. However, large scale studies are required to prove it conclusively.
- The Journal of Bone and Joint Surgery 07/1969; 51(4):737-55. · 3.23 Impact Factor
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ABSTRACT: A series of 236 patients over the age of 80 with intertrochanteric fractures were treated on a protocol established basis in an attempt to decrease postoperative morbidity and mortality. Rigid fixation with interfragmentary compression using the compression hip screw permitted us to begin early mobilization and immediate weight-bearing. Vigorous pulmonary tiolette, prophylactic antibiotics, and aspirin "anticoagulation" were used as adjuncts. Three month mortality was 7%. Overall, 76% of the patients who ambulated in any manner before their fracture walked again after surgery. Many, however, lost one grade level of walking postoperatively. Effective treatment for a patient with an intertrochanteric fracture, regardless of advanced age, is surgery and early mobilization.Clinical Orthopaedics and Related Research 07/1979; · 2.79 Impact Factor
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ABSTRACT: The results of 55 consecutive hemiarthroplasties in 54 elderly patients with intertrochanteric fractures were reviewed. The mean age of the patients was 84.2 years (range, 73-99 years). Standard cemented hemiarthroplasty was used and the fractured posteromedial fragment was retained. Two patients were lost to followup and 12 patients died within 6 months of their fractures. The mean length of followup was 13.6 months (range, 6-24.6 months) for the remaining 40 patients (41 hips). Nineteen patients maintained the same walking category as before fracture and eight of these patients had no increase in the dependency on walking aids. The greatest deterioration of walking function occurred in the subgroup of six patients who had a history of confusion and frequent falls. The medical complications are comparable with those described in other series. There were few surgical complications. The authors of this study think that the use of standard cemented hemiarthroplasty is a reasonable alternative to a sliding screw device for the treatment of intertrochanteric fractures. Longer-term studies with larger numbers of patients are required to address the issues of late complications and whether the reconstructions are durable enough for the long-surviving patients.Clinical Orthopaedics and Related Research 03/2000; · 2.79 Impact Factor