Comparative Study Between Intramedullary Fixation and Arthroplasty for the Management of Unstable Trochanteric Fracture in Elderly

Background: Intertrochanteric fractures involve those occurring in the region extending from the extra capsular basilar neck region to the region along the lesser trochanter proximal to the development of the medullary canal, these fractures account for forty percent of proximal femoral fractures in elderly.Aim of the Work: is to compare intramedullary fixation and hip arthroplasty in treatment of unstable trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome and patient satisfaction.Patients and Methods: The thesis is a prospective comparative randomized study between PFN and Hemiarthroplasty for the treatment of unstable trochanteric fractures in elderly. Patients were followed up at 1, 3, 6, 12 month postoperative, clinical and radiological data collected and documented starting from perioperative data (operative time, blood loss, transfusion).Results: We compared intramedullary fixation and hip arthroplasty in treatment of unstable, comminuted trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome. We did our best to execute it in an objective unbiased scientific manner by allocating patients randomly into two groups using closed opaque envelops. This was confirmed by the mean personal data (Age, sex), side of the fracture, pre-existing comorbidities, and fracture type according to AO classification, both groups were comparable, with no significant difference. Comparison of operative data showed significant difference in operative time, mean operative time was [78.4 min for group 1 Vs 112.6 min for group 2], favoring group 1 as less operative time.Conclusion: Hemiarthroplasty could be valid option in management of unstable trochanteric fractures in elderly, giving the advantage of early full weight bearing, yet it is more technically demanding, require higher surgical experience.