A Comparative study on functional outcome of unstable intertrochanteric fractures in elderly treated with bipolar hemiarthroplasty and dynamic hip screw

INTRODUCTION: Proximal femoral fractures in elderly individuals have a tremendous impact on both the health care system and society and it occurs in moderate or minimal trauma. During an impact the large amount of energy that is released is absorbed by the skin, fat, and muscles which surrounds the hip. There is an increased incidence of hip fractures with aging due to decrease in muscle mass around the hip and osteoporosis and is becoming more common as the proportion of elderly people in the population increases. Trochanteric hip fractures in elderly patients have benefited from advances in internal fixation. Early failure of internal fixation occurs however in a number of cases. The failure after internal fixation had been due to initial fracture pattern, communition, sub optimal fracture fixation and poor bone quality. The problems associated with fixation of these fractures are loss of fixation, varus collapse and cut out of the lag screw, as a result there is profound functional disability and pain. In these patients treatment with primary bipolar hemiarthroplasty decreases the post operative complications due to prolonged immobilization or implant failureand also quickly return the patients to their preinjury activity level. AIM OF THE STUDY: The aim of this Prospective comparative study is to analyse the short term follow up results of unstable Intertrochanteric fractures in elderly treated with Bipolar hemiarthroplasty and Dynamic hip screw fixation done in our institution from May 2010 to December 2012. MATERIALS AND METHODS: This study was conducted at Rajiv Gandhi Government General Hospital and Madras Medical college from May 2010 to December 2012 on 42 elderly osteoporotic patients with unstable inter trochanteric fractures who were divided in to two groups with Group A – bipolar prosthesis (21 cases) and Group B – DHS (21 cases). Inclusion criteria:- 1. Age more than 60 years, 2. Unstable intertrochanteric fractures (AO-ATO & EVANS classification), 3. Osteoporotic fractures. Exclusion criteria: - 1. Age less than 60 years, 2. Patients with stable intertrochanteric fractures(AO-ATO & EVANS classification), 3. Patients with pathological fractures, 4. Patients with stable lesser trochanter, 5. Patients with associated fractures of lower limbs. RESULTS: This study was conducted at Rajiv Gandhi Government General Hospital and Madras Medical college from May 2010 to December 2012 on 42 elderly osteoporotic patients with unstable inter trochanteric fractures who were divided in to two groups with Group A - Bipolar prosthesis (21 cases) and Group B – DHS (21 cases). Patients were evaluated clinically using Harris hip score during their follow up period. CONCLUSION: From our results, we are of the opinion that bipolar hemiarthroplasty may be an efficient option in elderly osteoporotic intertrochanteric fractures. It reduces the potential complications of prolonged immobilization such as pressure sores, pulmonary complications etc by early mobilization. As there is improved function and decreased hospitalization it seems to be cost effective. Though the results are encouraging in short term, a larger prospective study comparing internal fixation and hemiarthroplasty is needed in long term