Abstract: Introduction: Intertrochanteric femur (IT) fracture is a common fracture in old age. The cause of morbidity and mortality in IT femur is malunion, non-union, respiratory tract infections and bed sores, etc. DHS and PFN are time-tested treatment modalities but with availability of better implants and hemiarthroplasty techniques, mortality and morbidity can be reduced.
Aims and objectives: To study and com- pare the advantages and disadvantages of hemiarthroplasty over dynamic hip screw and proximal femur nail for management of elderly unstable intertrochanteric fracture femur.
Method and Materials: 120 patients of age 60 years and above, who were admit- ted and operated between October 2017 and March 2019 and had fulfilled the inclusion criteria, were enrolled for this study. Case selection was random.
Bipolar Hemiarthroplasty: Total numbers of patients was 40, mean age 80.2 years, F: M ratio 14:26, follow-up period 1.1 years. DHS: Total numbers of patients was 40, mean age 70.1 years, F:M ratio 18:22, follow-up period 6 months.
PFN: Total no of patients was 40, mean age 68.3 years, F:M ratio 11:29, follow-up period 6 months. Harris hip Scoring System assessed post operatively.
Result: For result assessment and evaluation, we use Harris hip score, T-test, Chi- square test, and statistical analysis. P value< 0.05 is considered significant.
Bipolar group: 1 had superficial wound infection, 1 had bed sore, and none had deep infection or pulmonary infection. Over all minimum post-operative complication and early mobilization seen. DHS group had maximum complication, PFN group had mixed results. Minimum blood loss seen with PFN and maximum with bipolar group. Excellent result observed at the end of 1 year: all patients who came for follow-up had good-to-excellent results.
Conclusion: Functional recovery was delayed with internal fixation group. Early post-operative Harris hip score was better in patients treated with hemiarthroplasty as compared to internal fixation group but at the end of 1 year, score was comparable. Post-operative complications were more in internal fixation group than in hemiarthroplasty group and were comparable with other studies. Thus, in conclusion, primary hemiarthroplasty does provide a stable, pain-free, and mobile joint with acceptable complication rate as seen in our study; however a larger prospective randomised study comparing the use of dynamic hip screw and proximal femur nail against primary hemiarthroplasty for unstable intertrochanteric fracture is needed.
