A Comparative Study of Fixation Versus Hemiarthroplasty in Complex Intertrochanteric Fractures in Elderly

Background: The objective of this study lies in the comparison of clinical outcomes and complications of internal fixation vs. hemiarthroplasty in complex (unstable osteoporotic) intertrochanteric fractures, AO/OTA 31 A2.1–31 A2.3, in elderly patients (aged more than 60 years). Materials and Methods: A prospective and randomized study was originally performed on 60 patients, in which 30 patients underwent hemiarthroplasty, and the rest underwent internal fixation. All cases were evaluated and followed for 18 months, both clinically and radiographically. Harris Hip Score was used for comparison and clinical outcome. Results: At a mean follow-up of 12 months in this study, fixation lagged behind hemiarthroplasty in terms of radiological and functional outcomes, but the Harris hip score after one and a half years of follow-up showed almost comparable results. The average age of patients in the fixation and hemiarthroplasty groups was 71.33 years and 73.58 years, respectively. The average hospital stay was 12 days for fixation (range 8–16) and 16 days for hemiarthroplasty (range 12–20). The average operation time was 48 min; the average blood loss was 72 mL in the case of internal fixation, whereas the average operation time and average blood loss were 68.4 min and 194 mL, respectively, in the hemiarthroplasty group. Discussion: Currently, intramedullary nails are widely used in treating these fractures because of their biological advantage, minimally invasive approach, short duration of surgery, and less blood loss. However, in the treatment of unstable intertrochanteric fractures in elderly patients with osteoporotic bones, internal fixation may fail, resulting in poor radiological and functional outcomes. Conclusion: The study concludes that the use of hemiarthroplasty reduced implant-related complications and allowed early weight bearing, ambulation, and rehabilitation. It had a lower percentage of patients with delayed complications but had no obvious statistical difference in terms of hospital stay and postoperative treatment complications. However, fixation results in less blood loss and transfusion requirements and a shorter operation time.