Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty

Abstract

A prospective, comparative study was done over a period of 3 years to compare the complications and functional results of two treatment modalities of unstable intertrochanteric fractures of the femur in the elderly; i.e closed reduction and internal fixation (CRIF) with proximal femur nail (PFN) and primary cemented hemireplacement arthroplasty (HRA) with bipolar prosthesis. 100 elderly patients with unstable intertrochanteric fractures of femur were studied over a period of 3 years. 50 patients underwent CRIF with PFN and 50 patients were treated with primary cemented hemireplacement arthroplasty with bipolar prosthesis. Harris Hip score analysis revealed that the difference between the patients treated with cemented hemiarthroplasty and proximal femoral nailing was statistically significant in favour of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point and reversed at the 12 month time point indicating a better functional outcome of Proximal Femur Nail in the long term. Although cemented hemireplacement arthhroplasty allows early pain free mobilization and has a good short term outcome, over time it is associated with a variety of complications which significantly affects quality of life of patients. On the other hand, although patients treated with PFN had delayed post op mobilization, they had better results when followed up at 1 year post surgery.

Keywords: Cemented hemireplacement arthroplasty; Proximal femur nail; Unstable intertrochanteric femur.

Figures

Fig. 1

Bending of prosthesis was seen in 1 case in the Cemented Bipolar group. It was treated with redoing with Modular Bipolar Prosthesis and locking plate and screws.

Fig. 2

1 of the patients suffered a dislocated bipolar prosthesis which was treated by closed reduction under General Anaesthesia.

Fig. 3

A peri-prosthetic fracture was sustained by 1 of the patients in the Cemented Bipolar group due to a fall following surgery. It was treated with a 3.5 mm Locking compression plate.

Fig. 4

Cemented bipolar prosthesis for a case of unstable Intertrochanteric fracture at 2 days and 3 months post-op.

Fig. 5

Unstable intertrochanteric fracture treated with PFN at 3 months post op with signs of good union.