Treatment of unstable intertrochanteric fracture femur by proximal femoral nail (PFN) versus cemented bipolar hemiarthroplasty

Document Type : Original Article

Authors

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

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

Abstract

Background: Treatment of unstable intertrochanteric fractures in elderly osteoporotic patients is challenging and still controversial. The key point of surgical treatment is to achieve 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 the treatment of unstable intertrochanteric fractures. As regards time to full weight bearing, operative time, blood loss, and post-operative complications.
Methodology: This interventional double-blinded study was conducted on 50 patients with unstable intertrochanteric fractures who were divided into two groups: Group 1 (PFN group): included 25 patients treated with direct or indirect reduction and fixation with PFN, and group 2 (BH group): included 25 patients treated with cemented BH. Clinical and functional evaluation had been achieved by Harris Hip Score (HHS). Both groups were matched regarding age, sex, site of fracture and operative characteristics.
Results: 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 the PFN group. The BH group had a higher rate of full weight bearing with statistical significantly shorter full weight bearing time compared to the PFN group. [(96% vs. 72%) and (8.67 ± 3.03vs. 12.06 ± 3.59) respectively. Patients in BH group had better insignificant Harris Hip Score scores compared to those in PFN group.
Conclusion: The 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 to recover more quickly.

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