Proximal femur nail vs cemented bipolar prosthesis in unstable intertrochanteric femur fractures in elderly: A prospective study

Abstract

Background: Surgical stabilization of Intertrochanteric fracture femur is one of the most commonly performed orthopaedic procedures. Present study was done to analyse the outcome of various treatment modalities for unstable Intertrochanteric fracture femur in elderly. Methods: The present clinical study was carried out at our tertiary care hospital. Study duration was from Jan 2015 to June 2016. 70 patients over the age of 60 years with unstable Intertrochanteric fracture were selected. Outcome of management of unstable Intertrochanteric fracture femur was analysed using Harris Hip Score in Proximal femoral nail (PFN) and Cemented Bipolar prosthesis (CBP). Results: Most of the patients were between 60-70 years of age. The average age of study group was 68.9 years. 35 patients treated with PFN and 35 patients treated with CBP. Superficial infection was seen in 4 patients and was the most common complication found in cemented bipolar prosthesis. External rotation deformity was second most common complication seen in 5 patients. Out of them, 2 patients were of CBP and 3 patients of PFN. Deep wound infection occurred in 1 case of CBP. Average blood loss in patients operated with PFN and CBP were 205 ml and 311ml in CBP. It was noted that shorter time was required for P.F.N (55 min) and then for CBP (84min). Average Harris score for PFN and CBP at 3 months, at 1 year and at 2 years were 70.1:74.9, 86.4:78.2 and 84.4:76.6. Conclusion: Considering the amount of blood loss, duration of the surgery and Harris Hip Score, PFN is better for unstable inter trochanteric fracture femur than CBP. The only advantage of Hemiarthroplasty was early weight bearing. But at the end of 1 year and 2 years, the outcome of PFN was better than Cemented Bipolar prostheses. Statistical method: Data were reported as mean, median (range) or number. t-test was used to assess significant difference among all numerical parameters of the study within the two surgical groups. P–values < 0.05 were considered statistically significant.