Abstract
Purpose
To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty in reverse oblique intertrochanteric hip fracture in elderly patients.
Materials and Methods
From January 2005 to July 2012, we reviewed 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and been followed up on for a minimum of 2 years. The patients, all over 70 years old, were divided into two groups for retrospective evaluation: one group was treated with open reduction and internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with bipolar hemiarthroplasty (22 cases).
Results
Early ambulation postoperatively and less pain at postoperative three months were significantly superior in the bipolar hemiarthroplasty group. However, by 24 months postoperatively, the open reduction and internal fixation group had higher Harris scores and correspondingly less pain than the bipolar hemiarthroplasty 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 open reduction and internal fixation group underwent reoperation.
Conclusions
In the treatment of intertrochanteric fracture of the reverse oblique type, if the patient's health and bone quality are good, open reduction and internal fixation is considered to be the better choice. However, in cases of severe communition of fracture and poor bone quality along with high risk of early reduction failure, bipolar hemiarthroplasty is an alternative offering advantages in terms of early ambulation, less pain at early stages, and lower risk of reoperation.
