Key result
Internal fixation using the proximal femoral nail system yielded higher Harris scores at 24 months than bipolar hemiarthroplasty, but 4 of 31 internal fixation patients required reoperation.
Why the study?
Does internal fixation using the proximal femoral nail system improve clinical and radiological outcomes compared to bipolar hemiarthroplasty in elderly patients with reverse oblique intertrochanteric femoral fractures?
Cohort (n=53)
Does internal fixation using the proximal femoral nail system improve clinical and radiological outcomes compared to bipolar hemiarthroplasty in elderly patients with reverse oblique intertrochanteric femoral fractures?
Internal fixation offers better long-term functional outcomes for reverse oblique intertrochanteric fractures in elderly patients with good bone quality, while BHA provides early mobilization benefits for those with poor bone quality.
Patient selection by bone quality may balance early mobility against long-term function; leaves open need for prospective trials in reverse oblique fractures.
PURPOSE: To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. MATERIALS AND METHODS: From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). RESULTS: Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. CONCLUSION: In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.
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Park et al. (2015) conducted a cohort in Reverse oblique intertrochanteric hip fractures (n=53). Internal fixation using the proximal femoral nail system vs. Bipolar hemiarthroplasty (BHA) was evaluated on Clinical and radiological results (ambulation, pain, Harris scores, union rate, reoperation). Internal fixation using the proximal femoral nail system yielded higher Harris scores at 24 months than bipolar hemiarthroplasty, but 4 of 31 internal fixation patients required reoperation.
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