Bipolar hemiarthroplasty with calcar substitution for unstable osteoporotic extracapsular hip fractures | ||||
| The Egyptian Orthopaedic Journal | ||||
| Volume 49, Issue 3, July 2014, Page 202-208 PDF (636.89 K) | ||||
| DOI: 10.4103/1110-1148.148187 | ||||
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| Author | ||||
| Samir M. El-Ghandour | ||||
| Abstract | ||||
| Background Hip fractures are the most frequent cause of morbidity in elderly people, and as the world's population ages, these fractures pose a significant healthcare problem. The management of unstable osteoporotic intertrochanteric fractures is challenging because of the 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, and this might result in higher chances of complications. Aim of the work The purpose of this study was to analyse the role of primary bipolar hemiarthroplasty with the calcar substitution design for the treatment of unstable osteoporotic intertrochanteric hip fractures. Patients and methods Seventeen patients with A2-type and A3-type unstable osteoporotic intertrochanteric fractures according to the WHO criteria and according to the System of the Orthopedic Trauma Association (AO/OTA) were treated with primary bipolar hemiarthroplasty with the calcar substitution design. There were 12 female and five male patients with a mean age of 66 years (range 62–74 years). The patients were followed up to a mean of 14 months (range 9–24 months) and evaluated according to the Harris Hip Score System. Results Two patients died in the third and the fifth months postoperatively after myocardial infarction and another two patients were lost for unknown causes. These four patients were excluded from the study, and the remaining 13 patients were followed up. The mean operative time was 115 min (range 90–160 min), and the average intraoperative blood loss was 450 ml (range 300–950 ml). Three patients needed blood transfusion postoperatively. The patients walked on an average of 3.2 days after surgery (range 2–8 days), and the average time taken to return to normal daily activities was 28 days (range 24–33 days). At the last follow-up, a total of 10 patients were graded as excellent or good and three as fair; nine patients were walking without any aid, three patients had a limp and used a stick for walking and one patient used a walker. One patient had superficial skin infection and another one had dislocation due to trauma 4 months postoperatively. Follow-up radiographs revealed acetabular erosion in two patients and nonunion of the greater trochanter in one patient. These three patients were ranked to have fair results. Conclusion Bipolar hemiarthroplasty with calcar substitution for unstable osteoporotic intertrochanteric fractures may allow early weight bearing and offers quick recovery with little risk of mechanical failure. It may also avoid the risks associated with internal fixation and enable the patient to maintain a good level of function immediately after surgery. | ||||
| Keywords | ||||
| calcar replacement; Hemiarthroplasty; Unstable Trochanteric Fractures | ||||
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