How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty

Background:  Due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly osteoporotic patients is challenging. The purpose of this study is to compare the results of hip arthroplasty (total, hemi, or bipolar) with DHS in the elderly patients with unstable intertrochanteric fractures.   Methods:  We prospectively studied and followed-up ۸۰ old patients with complex unstable intertrochanteric fracture from January ۲۰۰۷ to December ۲۰۱۰. Depending on the time of the patients’ admission, we alternatively treated them by DHS and arthroplasty, and placed them in Groups A and B, respectively. We followed them up radiologically and also clinically by Harris Hip Score for more than ۲۴ months. Statistical analysis was performed using SPSS version ۱۱.۵ for Windows.  Results: The mean length of follow-up and age were ۳۴.۳±۴.۱ months (ranged; ۲۴-۵۹) and the ۷۵.۲±۵.۲ years (ranged; ۵۸-۹۶), respectively. Comparing Group A with B, demographic data, mean blood loss, duration of operation, time to walking and duration of hospital stay had no significant difference but overall device related complications were significantly higher in Group A. Functional scores were also higher in Group B, but this difference was not significant statistically. In both groups, the patients with Type A۳ compared with Type A۲, had more duration of surgery and blood loss.  Conclusions:  Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates. 

Keywords:

Arthroplasty , Dynamic hip screw , intertrochanteric fracture , Unstable fracture