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Category: Volume 07 Issue 01 January 2019
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Title: Outcome of Primary Cemented Hemiarthroplasty in Unstable Trochanteric Fractures in Elderly Patients

Authors: Dr Neilakuo Kire, MS, Dr G. Thong, Dr K. Koutsu, Dr V. Viiprii

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.203

Abstract

Study Design: Prospective Study.

Background: Trochanteric fractures are one of the most common causes of high morbidity and mortality in elderly patients. Conservative treatments were seen to have a high complication rate with typical problems including decubiti, urinary tract infection, joint contractures, pneumonia, and thromboembolic complications, resulting in a high mortality rate. Most of the treatment methods of osteosynthesis in trochanteric fractures in elderly patients with gross communition along with osteoporosis does not provide fracture stability and bony union, leading to complications like non union, implant failure and femoral head perforation.

Objective:  To assess the post operativeclinico-radiologcal results and functional outcome using Harris Hip score.

Method: A prospective study was done with unstable intertrochanteric fracture in elderly who underwent cemented bipolar hemiarthroplasty in a single hospital by a single surgeon (n=50). Patients informed consent were taken, case sheets for relevant history and clinical examination, clinical instruments like measuring tape for measurement of limb length, goniometer for range of motion, Harris Hip Score, roentgenography at sequential follow-ups were taken.

Results: After applying the inclusion criteria in 50 patients, 41 patients were able to complete the follow-up. Out of 50 patients, 10 patients walked with the aid of a cane including the 6 patients, afore mentioned, who were already walking with the aid of a cane pre-injury state. In the last follow up 38 patients had excellent results, 3 patients had good results,7 patients died due to unknown reasons but unrelated to surgery and 2 patients did not turn up for their last follow up.

Conclusion: Primary cemented hemiarthroplasty as a treatment for unstable trochanteric fractures is a viable option for the elderly population. It results in early mobilization which avoids the hazards of prolonged inactivity and prevents implant failure due to osteoporosis. Hemiarthroplasty is a better option than internal fixation in the elderly of age taking into consideration their co-morbidities and poor bone stock due to osteoporosis, which can jeopardize internal fixation. Given that these fractures usually occur in the elderly, who are less mobile and less demanding, less strain is born by the prosthesis.

Keywords: unstable intertrochanteric fracture in elderly, primary cemented bipolar hemiarthroplasty, early mobilisation.

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Corresponding Author

Dr Neilakuo Kire

Orthopaedics, NHAK