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Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients; a comparison of 80 matched patients - 20/09/16

Doi : 10.1016/j.otsr.2016.04.007 
J.-D. Chang a, I.-S. Kim a, S.-S. Lee b, J.-H. Yoo c, , J.-H. Hwang d
a Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40 Seokwoo-dong, Hwasung 445-907, Republic of Korea 
b Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon 200-704, Republic of Korea 
c Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, Republic of Korea 
d Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1 Daerim-1dong, Yeongdeungpo-gu, Seoul 150-950, Republic of Korea 

Corresponding author. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, Republic of Korea. Tel.: +82 31 380 3770; fax: +82 31 382 1814.

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Abstract

Background

While hemiarthroplasty (HA) is considered the treatment of choice for displaced femoral neck (FN) fractures in elderly patients, HA has been partly performed as an alternative treatment option for unstable intertrochanteric (IT) fractures. However, there is a paucity of data regarding the risk and availability of HA for unstable IT fractures compared to HA for displaced FN fractures in elderly patients. Therefore, we performed this case-control study to determine whether HA for unstable IT fractures provides clinical results and survival comparable to HA for displaced FN fractures in elderly patients.

Hypothesis

HA for unstable IT fractures in elderly patients provides clinical results and 1-year survival comparable to HA for displaced FN fractures in the same aging group.

Materials and methods

We identified 80 patients aged 75years or older, who underwent cementless bipolar HA for unstable IT fracture (AO/OTA type 31-A2.2/3 and A3.3). Their clinical results and 1-year survival were compared to the matched control group of 80 patients with displaced FN fractures (Garden type 3 and 4) treated with the same procedure. Perioperative results, postoperative complications, and 1-year survival were investigated between the two groups. Functional outcome was assessed by walking status and Harris hip score (HHS) 6months after surgery.

Results

Operating time was significantly longer in the IT group than the FN group (97.3min [50 to 255] vs. 79.3min [40 to 175], P=0.016). However, the two groups did not significantly differ regarding perioperative results, such as total blood loss, transfusion, intraoperative fracture, length of hospital stay, and postoperative complication. No statistically significant differences in walking status and HHS were observed between the groups. No significant difference in cumulative survival was observed between the two groups (P=0.836), with a 1-year survival rate of 80% (95% confidence interval [CI], 71.8 to 87.5) in the IT group and 82% (95% CI, 73.1 to 89.4) in the FN group.

Conclusion

HA for unstable IT fractures in elderly patients showed clinical results and 1-year survival comparable to HA as the treatment of choice for displaced FN fractures in the same aging group.

Level of evidence

Level III, case-control study.

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Keywords : Unstable intertrochanteric fracture, Displaced femoral neck fracture, Cementless bipolar hemiarthroplasty, Case-control study


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Vol 102 - N° 6

P. 695-699 - octobre 2016 Retour au numéro
Article précédent Article précédent
  • Is arthroplasty preferable to internal fixation for the treatment of extracapsular fracture of the upper femur in the elderly?
  • P. Duriez, T. Devaux, C. Chantelot, N. Baudrier, J.-Y. Hery, D. Mainard, T. Favier, P. Massin
| Article suivant Article suivant
  • Periprosthetic fracture in the elderly with anatomic modular cementless hemiarthroplasty
  • P. Kouyoumdjian, A. Dhenin, A. Dupeyron, R. Coulomb, G. Asencio

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