Jagadeesh Kumar Jayapalan1, Parthasarathy Pandian2, Sankaralingam Pandian3, Chakravarthy Rajendiran4, Venkatesh Duraisamy5
INTRODUCTION: Unstable inter-trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut-out of the lag screw, are the common problems of attempts to fix these fractures. Present study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty and trochanter reconstruction in these patients.
MATERIALS AND METHODS: This prospective study included 30 cases of elderly osteoporotic patients with mean age of 65.4 years who sustained comminuted inter-trochanteric femur fracture treated with cemented bipolar hemiarthroplasty& tension band wiring for greater trochanter reconstruction. It is an essential technical step to avoid complication like abductor lurch gait. We here describe a technique of reconstruction and fixation of greater trochanter using tension band wiring in figure of eight pattern. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS).
RESULTS: The mean HHS score was was 85.6+SD 9.5 (range from 74 to 96). By the end of one year. The main clinical measures were early post-operative full weight bearing, post-operative complication & functional outcome. The time to full weight bearing, the rate of post-operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group. DISCUSSION: The changes in HHS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. The purpose of its use was that while Harris Hip Score (HHS) provides information on a multitude of factors. Superficial infection in 2 patients, anterior thigh pain in a patient, shortening less than 2cms in 2 patients, abductor lurch in a patient are the complications noted in post-operative period, but no patient required revision surgery.
CONCLUSION: The authors believe that primary cemented bipolar hemiarthroplasty for unstable inter-trochanteric fractures of femur in elderly does provide early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery.