Myung-Sik Park; Woo-Chul Jung; Hyuk Park; Byung-Yun Hwang; Young-Jin Lim; Myung-Guk Jung; Hong-Man Cho

doi:10.12671/jkfs.2009.22.3.138

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Original Article
Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty: Myung-Sik Park, M.D., Woo-Chul Jung, M.D., Hyuk Park, M.D., Byung-Yun Hwang, M.D., Young-Jin Lim, M.D., Myung-Guk Jung, M.D., Hong-Man Cho, M.D.; Journal of the Korean Fracture Society 2009;22(3):138-144.
DOI: https://doi.org/10.12671/jkfs.2009.22.3.138
Published online: July 31, 2009

Department of Orthopedic Surgery, Medical School, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

^*Department of Orthopedic Surgery, Saint Carollo Hospital, Sunchon, Korea.

^†Department of Orthopedic Surgery, Daejeon Veterans Hospital, Daejeon, Korea.

Address reprint requests to: Young-Jin Lim, M.D. Department of Orthopedic Surgery, Saint Carollo Hospital, 1742, Jo-ray-dong, Sunchon 540-718, Korea. Tel: 82-61-720-2500, Fax: 82-61-720-6000, lyj2834@naver.com

• Received: November 20, 2008 • Revised: May 27, 2009 • Accepted: June 24, 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
To perform comparative analysis between the results of internal fixation using compression hip screw and cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients.
Materials and Methods
From January 2001 to October 2006, we reviewd 73 patients, who were treated surgically for unstable intertrochanteric fractures, with a minimum of 2 years follow up. The patient's age was older than 60 year old. The patients were divided into two groups and evaluated, retrospectively. One group was treated with cemented bipolar hemiarthroplasty (Group A, 34 cases), and the other group was treated with compression hip screw (Group B, 39 cases). We evaluated the amount of intraoperative bleeding, operative time, clinical results and complications between the two groups.
Results
The amount of intraoperative bleeding and operative time were no statistically significant between the two groups. Group A showed a better result than Group B for clinical outcome using Johnson Daily Activity of Life. Complications in the group A were comprised of dislocation (1 case), nonunion of greater trochanter (1 case), infection (1 case) and loosening (1 case), and those in the group B were comprised of loss of fixation (8 cases) and infection (1 case).
Conclusion
We found that short-term outcomes of cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures were satisfactory. However, a longer-follow up period is necessary to clarify the efficacy of cemented bipolar hemiarthroplasty.
Key words: Intertrochanteric fracture, Bipolar hemiarthroplasty, Compression hip screw

REFERENCES

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3. Donnelly WJ, Kobayashi A, Freeman MA, et al. Radiological and survival comparison of 4 methods of fixation of a proximal femoral stem. J Bone Joint Surg Br, 1997;79:351-360.
4. Giliberty RP. A new concept of a bipolar endoprosthesis. Orthop Review, 1974;3:40-45.
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6. Haentjens P, Casteleyn PP, De Bocck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am, 1989;71:1214-1225.
7. Holt EPJ. Hip fractures in the trochanteric region: treatment with a strong nail and early weight-bearing: a report of one hundred cases. J Bone Joint Surg Am, 1963;45:687-705.
8. Hwang DS, Lee KJ, Choi JH. Recovery of walking ability after treatment of unstable intertrochanteric fractures in elderly patients-comparison of compression hip screw to primary hemiarthroplasty. J Korean Hip Soc, 1999;11:22-29.
9. Jensen JS, Sonne-Holm S, Tondevold E. Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation. Acta Orthop Scand, 1980;51:949-962.
10. Johnston RC, Fitzgerald RM, Harris WH, Poss R, Muller M, Sledge CB. Clinical and radiographic evaluation of total hip replacement: a standard system of terminology for reporting results. J Bone Joint Surg Am, 1990;72:161-168.
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Fig. 1

A 78-year-old female with right intertrochanteric fracture of the femur with severe osteoporosis.

(A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification.

(B) Postoperative radiogragh shows bipolar hemiarthroplasty state augmented with circumferencial and tension band wiring.

(C) Last follow-up radiogragh at postoperative 38 months shows stable fixation.

Fig. 2

A 74-year-old male with left intertrochanteric fracture of the femur.

(A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification.

(B) Immediate postoperative radiograph shows no restoration of medial cortex and fixation with compression hip screw.

(C) Follow up of 5 months radiograph shows cut-out of compression hip screw.

(D) The radiograph at 25 months postoperative after fixation shows healing of the fracture despite excessive cut-out of compression hip screw.

Table 1

Demographic characteristics between the group A and B

I: Independant T-test, C: Chi-square test.

Table 2

Johnson daily activity of life (Johnson, J Bone Joint Surg Am, 1990)

Table 3

Clinical results

Chi-square test (p=0.01).

Table 4

Complications during follow-up period

Chi-square test (p=0.01).

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis
Jun-Il Yoo, Yong-Chan Ha, Jae-young Lim, Hyun Kang, Byung-Ho Yoon, Hyunho Kim
Journal of Korean Medical Science.2017; 32(5): 858. CrossRef
The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures
Yee-Suk Kim, Jae-Seung Hur, Kyu-Tae Hwang, Il-Yong Choi, Young-Ho Kim
Hip & Pelvis.2014; 26(2): 99. CrossRef

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Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

J Korean Fract Soc. 2009;22(3):138-144. Published online July 31, 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.3.138

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Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

Fig. 1 A 78-year-old female with right intertrochanteric fracture of the femur with severe osteoporosis. (A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification. (B) Postoperative radiogragh shows bipolar hemiarthroplasty state augmented with circumferencial and tension band wiring. (C) Last follow-up radiogragh at postoperative 38 months shows stable fixation.

Fig. 2 A 74-year-old male with left intertrochanteric fracture of the femur. (A) Preoperative radiograph shows unstable intertrochantertic fracture by Evans classification. (B) Immediate postoperative radiograph shows no restoration of medial cortex and fixation with compression hip screw. (C) Follow up of 5 months radiograph shows cut-out of compression hip screw. (D) The radiograph at 25 months postoperative after fixation shows healing of the fracture despite excessive cut-out of compression hip screw.

Fig. 1

Fig. 2

Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

Table 1

Demographic characteristics between the group A and B

I: Independant T-test, C: Chi-square test.

Table 2

Johnson daily activity of life (Johnson, J Bone Joint Surg Am, 1990)

Table 3

Clinical results

Chi-square test (p=0.01).

Table 4

Complications during follow-up period

Chi-square test (p=0.01).

Table 1 Demographic characteristics between the group A and B

I: Independant T-test, C: Chi-square test.

Table 2 Johnson daily activity of life (Johnson, J Bone Joint Surg Am, 1990)

Table 3 Clinical results

Chi-square test (p=0.01).

Table 4 Complications during follow-up period

Chi-square test (p=0.01).