Treatment of Unstable Intertrochantric Fracture Femur by Proximal Femoral Nail (PFN) Versus Cemented Bipolar Hemiarthroplasty

Elsagheer, Mohammad Sayed; Abd-el-Baki, Gad Ragheb; Albehairy, Hassan Fathi; Abdelfattah, Mohammad Ahmed

doi:10.21608/jram.2023.223630.1219

Treatment of Unstable Intertrochantric Fracture Femur by Proximal Femoral Nail (PFN) Versus Cemented Bipolar Hemiarthroplasty

Document Type : Original Article

Authors

¹ Department of Orthopaedic Surgery, Qalyub Specialized Hospital, Qalyub, Egypt

² Department of Orthopaedic Surgery, Faculty of Medicine for girls, Al-Azhar University,Cairo,Egypt

³ Department of Orthopaedic Surgery, Faculty of Medicine for girls, Al-Azhar University

⁴ Department of Orthopaedic Surgery, Faculty of Medicine for girls, Al-Azhar University, Cairo, Egypt

10.21608/jram.2023.223630.1219

Abstract

ABSTRACT

Background: Treatment of unstable intertrochanteric fractures in elderly osteoporotic patients is challenging and still controversial. Key point of surgical treatment is to achieve an early mobilization with full-weight bearing which can be achieved by good anatomical reduction and fixation, or by hip arthroplasty.

Objective: This study aimed to compare the results of using proximal femoral nail (PFN) versus cemented bipolar hemiarthroplasty (BH) in treatment of unstable intertrochanteric fractures. regarding time to full weight bearing, operative time, blood loss and post operative complications.

Methodology: This prospective double blinded study was conducted on 50 patients with unstable intertrochanteric fractures who were divided into two groups:

Group (A) PFN group: that included 25 patients who were treated by direct or indirect reduction and fixation with PFN. Group (B): BH group that included 25 patients treated with cemented BH. Clinical and functional evaluation had been achieved by Harris Hip Score (HHS).

Results: Both groups were matched regarding age, sex, site of fracture and operative characteristics. The operative characteristics and the rate of intraoperative complications were similar between both groups. The length of hospital stay / days was nearly the same between both groups. The rate of bed sores and wound infections were non- significantly higher in PFN group .BH group has higher rate of full weight bearing with significantly shorter full weight bearing time compared to PFN group. [(96% vs. 72%) and (8.67 ± 3.03vs. 12.06 ± 3.59) respectively]. Patients in BH group had better Harris Hip Score scores compared to those in PFN group but without significant difference.

Conclusion: Studied BH group had shorter operating times, fewer fluoroscopic assessments, and early ambulation than those who underwent PFN.Therefore, we suggest that BH may help elderly patients with osteoporotic unstable intertrochanteric fractures recover more quickly.

Keywords: Cemented bipolar hemiarthroplasty; proximal femoral nail; BH. PFN.

Keywords