Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing

Backround: Intertrochanteric fractures in the elderly pose certain special problems and need to be addressed in a balanced way as on one hand senile osteoporosis requires prolonged immobilization, on the other hand rapid mobilization is required as they are generally medically compromised due to age and associated diseases. Despite several randomized trials and comparative studies treatment of unstable intertrochanteric fractures in elderly patients is still controversial, which we want to investigate in this set-up which caters to a vast rural population. Methods: A retrospective analysis of 54 patients, of which 27 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2012 till July 2016 was done. Primary outcome was assessed in both groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. All complications were noted at follow ups. Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 77.81 for BPA and 71.18 for PFN (p-value = 0.001) and at 1 year of follow up was 85.55 for BPA and 77.03 for PFN (p-value = 0.001). Statistically significant differences were found between BPA and PFN groups with reference to intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. Conclusion: The bipolar hemiarthroplasty group had fewer complications and earlier mobilization with better Harris hip score at all follow ups, which indicate bipolar hemiarthroplasty is a better option in the treatment of unstable intertrochanteric fractures in senile osteoporotic patients.