A comparative study between cemented hemiarthroplasty and proximal femoral nail in proximal femur fractures in elderly patients

Introduction: Incidence of fractures around the hip is increasing worldwide owing to increased life span of the people and secondary to osteoporotic fragile bones. Stable intertrochanteric fractures can be easily treated by internal fixation methods. Unstable comminuted and osteoporotic idsntertrochanteric fractures are very difficult to treat. They can be treated by internal fixation with proximal femoral nail. But chances of implant failure and non union are high with highly osteoporotic and comminuted fractures. In such cases primary hemiarthroplasty is an useful alternative option. We have compared the outcomes of unstable intertrochanteric fractures treated with hemiarthroplasty and proximal femoral nail. Materials and Methods: Our study was conducted in BGS Global Institute of Medical Sciences, Bangalore from January 2014 to December 2016 on patients who had sustained intertrochanteric fractures. It was a prospective study done for a period of two years. Patients with intertrochanteric fractures who had come to our hospital were included in our study. Patients aged more than 60 years with closed intertrochanteric fractures were included in the study. Patients were divided as group I- operated with hemiarthroplasty and group II- operated with proximal femoral nail. Functional outcome of both groups was assessed using Harris Hip scale and various parameters were compared. Results: Majority of the patients were in the age group 70-79 years, 16 being females and 14 males. Commonest mode of injury was trivial fall (83.33%). Average duration of hospital stay for hemi-arthroplasty patients was 14.33 days and for PFN patients was 11.86 days.15 patients had associated conditions like diabetes or hypertension. Average intra-operative blood loss was 516.66 ml for hemi-arthroplsty and 187.33 ml for PFN. Average operating time for hemi-arthroplasy was 80 minutes whereas for PFN was 83.33 minutes. Mean harris hip score at the end of one year for hemi-arthroplasty was 76.46 and for PFN was 77.8. Conclusion: The outcomes of both the modalities are almost equal. PFN has an advantage of shorter operative time, less blood loss, lower hospital stay with no difference in functional outcome or general complications as compared to hemiarthroplasty. Major advantage of PFN is patients treated with PFN can squat and sit cross legged after fracture union. Hemiarthroplasty does provide a stable, pain-free, and mobile joint with a very low complication rate as seen in our study; however a larger prospective randomized study with longer follow up comparing the use of PFN against primary hemi-arthroplasty for proximal femur fractures needs to be done.