A Comparative Study Evaluating the Outcomes of Primary Cemented Bipolar Hemiarthroplasty Versus Proximal Femoral Nail Osteosynthesis for Unstable Intertrochanteric Femur Fractures in the Elderly Patient

Objective: The objective of this study was to compare the outcomes of primary cemented bipolar hemiarthroplasty with proximal femoral nail (PFN) osteosynthesis as a management modality in unstable fractures of the intertrochanteric femur.

Introduction: Intertrochanteric fractures also referred to as extracapsular fractures occur in the area between the greater and lesser trochanters. Osteosynthesis is a prompt and efficient method for managing stable intertrochanteric fractures. Utilizing osteosynthesis procedures other than intramedullary fixation to address unstable intertrochanteric fractures has been linked to a relatively elevated failure rate. Hemiarthroplasty, a surgical procedure that avoids the problems of an IT fracture resulting from prolonged immobility and allows for early patient mobilization, could potentially resolve the problem. As part of this comparative analysis, we examined the surgical and functional results of PFN osteosynthesis and bipolar hemiarthroplasty in older patients with unstable intertrochanteric fractures.

Materials and methods: This study included 44 patients, consisting of 24 males and 20 females. The participants were chosen for the study depending on whether or not they met the specified criteria for inclusion and exclusion. The individuals presented with unstable intertrochanteric fractures. The study participants were included in the research after they gave their written informed consent in both English and regional languages. A total of 22 individuals underwent cemented bipolar hemiarthroplasty, whereas the remaining 22 cases underwent PFN osteosynthesis.

Results: In this study, a group of researchers monitored 44 patients who had unstable intertrochanteric femur fractures over 6 months. The subsequent results were generated by comparing the outcomes of the two groups after 1 month and 6 months: The mean duration of weight-bearing for patients who underwent bipolar hemiarthroplasty was 4 days, whereas, for patients who underwent PFN, it was 50 days. The mean blood loss following bipolar hemiarthroplasty is 288 ml, whereas the mean blood loss associated with PFN is approximately 174 ml. One month after undergoing bipolar hemiarthroplasty, the patient's Harris hip score was 69 and their PFN score was 59. The bipolar score at the 6-month follow-up was 76, whereas the PFN score was 78. The average duration of bipolar hemiarthroplasty was 84.8 min, whereas PFN had a duration of 67 min. In the group of patients who underwent bipolar hemiarthroplasty, the highest amount of shortening observed was 2.5 cm, whereas in the group of patients who underwent PFN, it was 2 cm.

Conclusion: Our study showed that by performing cemented bipolar hemiarthroplasty in unstable intertrochanteric fractures, we were able to prevent the problems commonly associated with internal fixation. In addition, we could facilitate prompt mobilization in geriatric patients, allowing them to regain their pre-injury level of functioning and enhance their overall quality of life. At the 1-month mark, bipolar hemiarthroplasty yielded superior early functional results compared to PFN. However, by the 6-month mark, both groups exhibited similar scores for functional outcomes. In conclusion, primary cemented bipolar hemiarthroplasty offers a stable, pain-free, and mobile joint with an acceptable rate of complications and improved early recovery.