Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series
Context: Inter-trochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation with dyna...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2012-01-01
|
| Series: | Medical Journal of Dr. D.Y. Patil University |
| Subjects: | |
| Online Access: | http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2012;volume=5;issue=1;spage=36;epage=42;aulast=Salunkhe |
| _version_ | 1811329714148605952 |
|---|---|
| author | Rahul M Salunkhe Shrirang Limaye Samar K Biswas Rahul P Mehta |
| author_facet | Rahul M Salunkhe Shrirang Limaye Samar K Biswas Rahul P Mehta |
| author_sort | Rahul M Salunkhe |
| collection | DOAJ |
| description | Context: Inter-trochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation with dynamic hip screw has been found to be high, especially in osteoporotic bones. Revision osteo-synthesis is technically demanding and leads to complications. Aim: To assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. Settings and Design: A Case series of 50 cases. Materials and Methods: We divided these fractures into three groups and accordingly the prosthesis was used. Group 1- intact calcar and lesser trochanter non-communited-AMP type of bipolar prosthesis, Group 2- fracture of calcar - Thompson′s type of bipolar prosthesis with calcar reconstruction, Group 3- group 2 + instability of postero-medial wall-modular type bipolar prosthesis with lesser trochanter and calcar reconstruction. Greater trochanter, calcar, and lesser trochanter were reconstructed with encirclage, tension band wiring, fashioned bone graft, or bone cement collar accordingly. Results: In our study of 50 cases with mean age 79.57 years, 20 cases were type 1, 19 type 2, and 11 type 3 fractures. The average Harris hip score was 79. Excellent to fair results were obtained at follow-up in 46 (92%) and in 4 (8%) results were poor. The mean Harris hip score was 83 (good) in Group- I, 79 (Fair) in Group- II, and 72 (Fair) in Group- III patients. Average hospital stay was 12.5 days. There were four cases of superficial operative site infection which were treated with short course of oral antibiotics. Four cases died of medical complications, earliest being 3 months, and latest being 18 months. No case of loosening of the prosthesis, break in the cement or sinking of prosthesis was seen. |
| first_indexed | 2024-04-13T15:48:46Z |
| format | Article |
| id | doaj.art-92ec04b3a6394461b016bebf9b23865e |
| institution | Directory Open Access Journal |
| issn | 0975-2870 |
| language | English |
| last_indexed | 2024-04-13T15:48:46Z |
| publishDate | 2012-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Medical Journal of Dr. D.Y. Patil University |
| spelling | doaj.art-92ec04b3a6394461b016bebf9b23865e2022-12-22T02:40:53ZengWolters Kluwer Medknow PublicationsMedical Journal of Dr. D.Y. Patil University0975-28702012-01-0151364210.4103/0975-2870.97510Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case seriesRahul M SalunkheShrirang LimayeSamar K BiswasRahul P MehtaContext: Inter-trochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation with dynamic hip screw has been found to be high, especially in osteoporotic bones. Revision osteo-synthesis is technically demanding and leads to complications. Aim: To assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. Settings and Design: A Case series of 50 cases. Materials and Methods: We divided these fractures into three groups and accordingly the prosthesis was used. Group 1- intact calcar and lesser trochanter non-communited-AMP type of bipolar prosthesis, Group 2- fracture of calcar - Thompson′s type of bipolar prosthesis with calcar reconstruction, Group 3- group 2 + instability of postero-medial wall-modular type bipolar prosthesis with lesser trochanter and calcar reconstruction. Greater trochanter, calcar, and lesser trochanter were reconstructed with encirclage, tension band wiring, fashioned bone graft, or bone cement collar accordingly. Results: In our study of 50 cases with mean age 79.57 years, 20 cases were type 1, 19 type 2, and 11 type 3 fractures. The average Harris hip score was 79. Excellent to fair results were obtained at follow-up in 46 (92%) and in 4 (8%) results were poor. The mean Harris hip score was 83 (good) in Group- I, 79 (Fair) in Group- II, and 72 (Fair) in Group- III patients. Average hospital stay was 12.5 days. There were four cases of superficial operative site infection which were treated with short course of oral antibiotics. Four cases died of medical complications, earliest being 3 months, and latest being 18 months. No case of loosening of the prosthesis, break in the cement or sinking of prosthesis was seen.http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2012;volume=5;issue=1;spage=36;epage=42;aulast=SalunkheCemented hemiarthroplastydirect approach to fracture siteosteoporosisproximal femoral fractures |
| spellingShingle | Rahul M Salunkhe Shrirang Limaye Samar K Biswas Rahul P Mehta Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series Medical Journal of Dr. D.Y. Patil University Cemented hemiarthroplasty direct approach to fracture site osteoporosis proximal femoral fractures |
| title | Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series |
| title_full | Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series |
| title_fullStr | Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series |
| title_full_unstemmed | Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series |
| title_short | Cemented hemi-arthroplasty in proximal femoral fractures in elderly with severe osteoporosis: A case series |
| title_sort | cemented hemi arthroplasty in proximal femoral fractures in elderly with severe osteoporosis a case series |
| topic | Cemented hemiarthroplasty direct approach to fracture site osteoporosis proximal femoral fractures |
| url | http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2012;volume=5;issue=1;spage=36;epage=42;aulast=Salunkhe |
| work_keys_str_mv | AT rahulmsalunkhe cementedhemiarthroplastyinproximalfemoralfracturesinelderlywithsevereosteoporosisacaseseries AT shriranglimaye cementedhemiarthroplastyinproximalfemoralfracturesinelderlywithsevereosteoporosisacaseseries AT samarkbiswas cementedhemiarthroplastyinproximalfemoralfracturesinelderlywithsevereosteoporosisacaseseries AT rahulpmehta cementedhemiarthroplastyinproximalfemoralfracturesinelderlywithsevereosteoporosisacaseseries |