Primary Long Distal Fitting Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial. Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.