Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Shahid Beheshti Uni- versity of Medical Sciences, Tehran, Iran.

2 Department of Orthopedic Surgery, Shahid Beheshti Uni- versity of Medical Sciences, Tehran, Iran.

3 Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: At present, there is no consensus on an appropriate treatment modality for intertrochanteric fractures in the elderly with background diseases. The aim of the present study was to compare treatment outcomes of intertrochanteric fractures reduced with dynamic hip screws (DHS) and bipolar hemiarthroplasty in elderly patients with background medical conditions.
Methods: In this randomized clinical trial, 60 patients with intertrochanteric fractures, who were 45-60 years old, were randomly divided into DHS and bipolar groups. After treatment, the two groups were compared in relation to complications and mortality rates, functional status using the Harris Hip Score (HHS), range of movement and severity of pain using the visual analogue score (VAS). Results: HHS (86±9 vs. 75±7.6), range of flexion (105±11 degrees vs. 90±17 degrees) and external rotation (35±7 degrees vs. 20±7 degrees) were significantly higher in the bipolar group compared to the DHS group (P<0.05). However, there were no significant differences in pain severity between the two groups.
Conclusion: Reduction of intertrochanteric fractures in elderly patients with background medical conditions is more effective and less problematic with the bipolar technique compared to DHS and is better tolerated by patients, because this technique is associated with improvements in functional status and hip joint movement range.

Keywords

Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury.  2006; 37(8):691-7.

  • Leighton RK. Fractures of the neck of the femur. In: Bucholz RW, Heckman JD, Court–Brown CM, editors. Fractures in adults. 6th ed. Philadelphia: Lippincott; 2006: 1753-88.

  • Zhang Y, Tian L, Yan Y, Sang H, Ma Z, Jie Q, et al. Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures. Injury. 2011;42(11):1372-6.

  • Sendtner E, Renkawitz T, Kramny P, Wenzl M, Grifka J. Fractured neck of femur--internal fixation versus arthroplasty. Dtsch Arztebl Int. 2010;107(23):401-7.

  • Tooke SM, Favero KJ. Femoral neck fractures in skeletally mature patients, fifty years old or less. J Bone Joint Surg Am. 1985;67:1255-60.

  • Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomized controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89:160-5.

  • Lu-Yao GL, Keller RB, Littenberg, B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. J Bone Joint Surg Am. 1994;76:15-25.

  • Seyfettinoğlu F, Ersan O, Kovalak E, Duygun F, Ozsar B, Ateş Y. Fixation of femoral neck fractures with three screws: results and complications. Acta Orthop Traumatol Turc. 2011;45(1):6-13.

  • Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, Obremskey W, Koval KJ, et al. Internal fi xation compared with arthroplasty for displaced fractures of the femoral neck.J Bone Joint Surg Am. 2003;85:1673-81.

  • Ly TV, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop. 2008;42(1):3-12.

  • Sinno K, Sakr M, Girard J, Khatib H.The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients.N Am J Med Sci. 2010;2(12):561-8.

  • Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353 :878-82.

  • Clawson DK. Trochanteric Fractures Treated by the Sliding Screw Plate Fixation Method. J Trauma. 1964;(4):737-52.

  • Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979; 61(2): 216-21.

  • Yong C, Tan C, Penafort R. Dynamic hip screw compared to condylar blade plate in the treatment of unstable fragility intertrochanteric fractures. Malays Orthop J. 2009;3: 13-8.

  • Wolfgang GL, Bryant MH, O’Neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop. 1982; 163: 148-58.

  • Li P, Yang H, Zheng L, Shan HH. Postoperative complications of Dynamic hip screw and its prevention in the treatment of intertrochanteric fracture. J Dalian Med Univ. 2009; 3: 17.

  • Nordin S, Zulkifli O, Faisham WI. Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur. Med J Malaysia. 2001; (56): 12-7.

  • Laskin RS, Gruber MA ,Zimmerman AJ. Intertrochanteric fractures of the hip in the elderly: a retrospective analysis of 236 cases. Clin Orthop Relat Res. 1979;(141): 188-95.

  • Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Vannini F, Giannini S. Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am. 2005; 87(4):753-9.

  • Ehlinger M, Adam Ph, Delpin D, Moser T, Bonnomet F. Osteosynthesis of periprosthetic femoral fractures with Locking Plate fixation using an LCP: A consecutive series of 36 fractures with mean 26 months follow-up. J Bone Joint Surg Br. 2011; 93: 531.

  • Shah AK, Eissler J, Radomisli T. Algorithms for the treatment of femoral neck fractures. Clin Orthop Relat Res. 2002;(399):28-34.

  • Bhattacharyya T, Iorio R, Healy WL. Rate of and risk factors for acute inpatient mortality after orthopaedic surgery. J Bone Joint Surg Am. 2002;84:562-72.