Mahesh Prasad1, Neelu Prasad2
BACKGROUND Intertrochanteric fractures in the generic population are a common injury and are associated with the poor bone quality and hence management of unstable osteoporotic intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study is to analyse the role of primary hemiarthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures. AIMS AND OBJECTIVES
Find out the results of Hemiarthroplasty for intertrochanteric fracture in elderly patients from the population of Bihar. METHODS AND MATERIALS
Study Area: Departments of Orthopaedics, Nalanda Medical College and Hospital. All these patients with hip injury reporting in Emergency and OPD were clinically examined, those satisfying for the inclusion and exclusion criteria were taken for study and the total number of patients was 37 for the study. INCLUSION CRITERIA
1. Boyd Griffin type 3 and 4,
2. Evans and Jensen type 1c and type 2,
3. AO/OTA type a21 to a33,
4. Age > 60 years. EXCLUSION CRITERIA
Patient
1. ASA Grade – 1.
2. BG Grade – 1.
3. Less than 60 years.
4. With previous ipsilateral hip fracture.
5. With stable fracture and intact lesser trochanter.
6. With neurologic problem.
7. Psychiatric patient.
8. With multiple fractures.
9. Cataract.
10. Any severe cardiac disorder.
11. Medically unfit for surgery and patient unwillingness for surgery were excluded for study. RESULTS Total mortality was two patients due to unrelated cause (myocardial infarction) within 6 months of surgery and study period and remaining 35 patients were followed up in range of 18–39 months and on average 24.5 months. The surgery time range was 55–88 min. and with an average of 71 minutes. The intraoperative blood loss range was 175–500 mL and an average of 350 mL. Out of 35 patients, six patients needed blood transfusion postoperatively. The patients walked on in 2 to 8 days, an average 3.2 days after surgery. One patient had superficial skin infection and one had bed sore with no other significant postoperative complications. One patient of Alzheimer’s disease refused to walk and had a poor result. A total of 32 out of 35 patients (91%) had excellent-to-fair functional results and 2 had poor result with respect to the Harris hip score (mean 84.8±9.72, range 58-97). One patient who had neurological comorbidity refused to walk postoperatively and was recognised as failed result. CONCLUSION Hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in elderly results in early ambulation and good functional results although further prospective randomised trials are required before reaching to conclusion.
