Bipolar arthroplasty in highly comminuted intertrochanteric fractures

A hip fracture represents a disturbing and potentially ominous land mark in personal health history. For the health care system and to society in general, intertrochanteric fractures represent an epidemic disease. The present study is being carried out to assess the role of bipolar arthroplasty in case of highly comminuted intertrochanteric fracture of femur. After proper preoperative assessment bipolar arthroplasty was done and results were evaluated. Materials and Method: Thirty cases of highly comminuted intertrochanteric fractures were treated with bipolar arthroplasty. Adult patients after closure of the epiphysis and all the cases of highly comminuted inter-trochanteric femur fractures were included in the study. Patients with active infection of hip joint or any other region, any unstable medical illness that would significantly increase the risk of morbidity and mortality and patients before closure of epiphysis were excluded from the study. Follow up was done at stitch removal and then at 1 month interval for 6 months and then 6 months interval for 2 years. Results: 18 cases (60%) were operated within one week of admission, 9 patients (30%) between 8-14 days and 3 patients (10%) were operated after 15 days. This delay was caused in those cases who required management of associated problems. Primary bipolar cemented arthroplasty was done in all cases. 16 patients (53.33%) were ambulated within 10-14 days and 12 patients (40%) were ambulated within 15-21 days and 2 patients (6.67%) were ambulated after 21 days, because one of the patients was having associated injury of supracondylar fracture femur for which DCS was applied before operation for ipsilateral intertrochanteric fracture femur and in 2nd patient ambulation was delayed as this patient developed DVT. 23 patients (76.67%) gave good results and 6 patients (20%) showed fair results and 1 patient (3.33%) showed poor result. Conclusion: Primary cemented bipolar arthroplasty is a viable and a suitable option for the treatment of comminuted unstable intertrochanteric fractures of femur as it lessens the duration of recumbency, permits early walking with full weight bearing, reduces the incidence of various postoperative complications of prolonged immobilization and minimizes the duration of hospital stay.