A Comparison of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation of Basicervical Femoral Neck Fractures
-
Ali Mousapour
,
Keykhosro Mardanpour
,
Adel hojabrian
,
Morteza Saeb
,
Seyyd Saeed Khabiri
,
Roya Safari-Faramani
,
Monireh Yaghoubi
,
Sepehr Rahimipour
,
Alireza Shafiee
Abstract
Background: Surgical treatment of basicervical femoral neck fractures, which is biomechanically similar to intertrochanteric fractures, is an internal fixation by DHS and anti-rotation screw. Since devise failure is one of the most noticeable complications of these surgical procedures, this study aimed to compare the bipolar Hemi-arthroplasty with DHS plate internal fixation in elderly patients with a basicervical femoral neck fracture.
Methods: This is a randomized controlled clinical trial in which 60 patients with femoral neck fractures were divided into two groups of 30 control (DHS fixation) and intervention (Bipolar hemiarthroplasty) randomly. Functional evaluation was completed by the HHS questionnaire and VAS scale for pain assessment, postoperative complications at 6 months and one year postoperatively. Data were analyzed using Stata software.
Findings: The overall mean age in the control group was 73.95± 9.85 and in the intervention group 74.22±7.85 years. Three patients in the intervention group and 6 patients in the control group were excluded. HHS in Sixth months and one year after surgery were significantly higher in the bipolar group compared to the DHS group(p-value<0.0003and p-value < 0.0097). there were no significant differences in VAS between the two groups (p-value<0.4557 and p-value < 0.4578).The rate of device failure in the control group was 2 cases.
Conclusion: Overall, the results of this study show that bipolar hemiarthroplasty surgery is more effective than internal fixation by DHS plate in improving the patients' quality of life based on the HHS scores, and the lower failure rate as well as diminishing of the reoperation rate.
1. Sendtner E, Renkawitz T, Kramny P, Wenzl M, Grifka J. Fractured neck of femur-internal fixation versus arthroplasty. Dtsch Arztebl Int. 2010;107(23):401-7. doi: 10.3238/arztebl.2010.0401. [PubMed: 20589205]. [PubMed Central: PMC2893522].
2. Gao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: A meta-analysis. Clin Orthop Relat Res. 2012;470(6):1782-91. doi: 10.1007/s11999-012-2250-6. [PubMed: 22278852]. [PubMed Central: PMC3348330].
3. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;(4):CD001708. doi: 10.1002/14651858.CD001708.pub2. [PubMed: 17054139].
4. Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur-13 year results of a prospective randomised study. Injury. 2000;31(10):793-7. doi: 10.1016/s0020-1383(00)00125-x. [PubMed: 11154750].
5. Xie H, Wang Z, Zhang J, Xu L, Chen B. Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients. Oncotarget. 2017;8(47):82700-4. doi: 10.18632/oncotarget.19754. [PubMed: 29137295]. [PubMed Central: PMC5669921].
6. Azar FM, Canale ST, Beaty HJ. Campbell's operative orthopaedics. Philadelphia, PA: Elsevier Health Sciences; 2016.
7. McLoughlin SW, Wheeler DL, Rider J, Bolhofner B. Biomechanical evaluation of the dynamic hip screw with two-and four-hole side plates. J Orthop Trauma. 2000;14(5):318-23. doi: 10.1097/00005131-200006000-00002. [PubMed: 10926237].
8. Bolhofner BR, Russo PR, Carmen B. Results of intertrochanteric femur fractures treated with a 135-degree sliding screw with a two-hole side plate. J Orthop Trauma. 1999;13(1):5-8. doi: 10.1097/00005131-199901000-00002. [PubMed: 9892117].
9. Su BW, Heyworth BE, Protopsaltis TS, Lipton CB, Sinicropi SM, Chapman CB, et al. Basicervical versus intertrochanteric fractures: An analysis of radiographic and functional
outcomes. Orthopedics. 2006;29(10):919-25. doi: 10.3928/01477447-20061001-04. [PubMed: 17061418].
10. Desjardins AL, Roy A, Paiement G, Newman N, Pedlow F, Desloges D, et al. Unstable intertrochanteric fracture of the femur. A prospective randomised study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br. 1993;75(3):445-7. [PubMed: 8496218].
11. CONSORT Transparent Reporting of Trails. CONSORT 2010 Flow Diagram [Online]. [cited 2010]; Available from: URL: http://www.consort-statement.org/download/Media/Default/Downloads/CONSORT %202010%20Flow%20Diagram.doc
12. Levy RN, Siegel M, Sedlin ED, Siffert RS. Complications of Ender-pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip. J Bone Joint Surg Am. 1983;65(1):66-9. [PubMed: 6848537].
13. Koval KJ, Cantu RV. Intertrochanteric fractures. In: Rockwood CA, Bucholz RW, Heckman JD, Court-Brown CM, Koval KJ, Tornetta P, et al., Editors. Rockwood and green's fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. p. 1793-825.
14. Bergman GD, Winquist RA, Mayo KA, Hansen ST Jr. Subtrochanteric fracture of the femur. Fixation using the Zickel nail. J Bone Joint Surg Am. 1987;69(7):1032-40. [PubMed: 3654694].
15. Sinno K, Sakr M, Girard J, Khatib H. The effectiveness of primary bipolar arthroplasty in treatment of unstable
intertrochanteric fractures in elderly patients. N Am J Med Sci. 2010;2(12):561-8. doi: 10.4297/najms.2010.2561. [PubMed: 22558568]. [PubMed Central: PMC3338223].
16. Hassankhani EG, Omidi-Kashani F, Hajitaghi H, Hassankhani GG. How to treat the complex unstable intertrochanteric fractures in elderly patients? DHS or Arthroplasty. Arch Bone Jt Surg. 2014;2(3):174-9. [PubMed: 25386578]. [PubMed Central: PMC4225022].
17. Kayali C, Agus H, Ozluk S, Sanli C. Treatment for unstable intertrochanteric fractures in elderly patients: Internal fixation versus cone hemiarthroplasty. J Orthop Surg (Hong Kong). 2006;14(3):240-4. doi: 10.1177/230949900601400302. [PubMed: 17200522].
18. Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop. 2002;26(4):233-7. doi: 10.1007/s00264-002-0358-0. [PubMed: 12185526]. [PubMed Central: PMC3620945].
19. Emami M, Manafi A, Hashemi B, Nemati A, Safari S. Comparison of intertrochanteric fracture fixation with dynamic hip screw and bipolar hemiarthroplasty techniques. Arch Bone Jt Surg. 2013;1(1):14-7. [PubMed: 25207277]. [PubMed Central: PMC4151394].
20. Thakkar CJ, Thakkar S, Kathalgere RT, Kumar MN. Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures. Indian J Orthop. 2015;49(6):602-9. doi: 10.4103/0019-5413.168762. [PubMed: 26806966]. [PubMed Central: PMC4705725].
21. Singh S, Shrivastava C, Kumar S. Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur. J Clin Diagn Res. 2014;8(10):LC01-LC04. doi: 10.7860/JCDR/2014/10171.4972. [PubMed: 25478376]. [PubMed Central: PMC4253194].
22. Broos PL, Rommens PM, Geens VR, Stappaerts KH. Pertrochanteric fractures in the elderly. Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution? Acta Chir Belg. 1991;91(5):242-9. [PubMed: 1950312].
23. Weidmann E, Huggler AH. Hip prosthesis in per-trochanteric fractures. Z Unfallmed Berufskr. 1976;69(3-4):147-50. [PubMed: 1014921]. [In French].
24. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64(9):1295-306. [PubMed: 7142237].
25. Kesmezacar H, Ogut T, Bilgili MG, Gokay S, Tenekecioglu Y. Treatment of intertrochanteric femur fractures in elderly patients: Internal fixation or hemiarthroplasty. Acta Orthop Traumatol Turc. 2005;39(4):287-94. [PubMed: 16269874].
2. Gao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: A meta-analysis. Clin Orthop Relat Res. 2012;470(6):1782-91. doi: 10.1007/s11999-012-2250-6. [PubMed: 22278852]. [PubMed Central: PMC3348330].
3. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;(4):CD001708. doi: 10.1002/14651858.CD001708.pub2. [PubMed: 17054139].
4. Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur-13 year results of a prospective randomised study. Injury. 2000;31(10):793-7. doi: 10.1016/s0020-1383(00)00125-x. [PubMed: 11154750].
5. Xie H, Wang Z, Zhang J, Xu L, Chen B. Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients. Oncotarget. 2017;8(47):82700-4. doi: 10.18632/oncotarget.19754. [PubMed: 29137295]. [PubMed Central: PMC5669921].
6. Azar FM, Canale ST, Beaty HJ. Campbell's operative orthopaedics. Philadelphia, PA: Elsevier Health Sciences; 2016.
7. McLoughlin SW, Wheeler DL, Rider J, Bolhofner B. Biomechanical evaluation of the dynamic hip screw with two-and four-hole side plates. J Orthop Trauma. 2000;14(5):318-23. doi: 10.1097/00005131-200006000-00002. [PubMed: 10926237].
8. Bolhofner BR, Russo PR, Carmen B. Results of intertrochanteric femur fractures treated with a 135-degree sliding screw with a two-hole side plate. J Orthop Trauma. 1999;13(1):5-8. doi: 10.1097/00005131-199901000-00002. [PubMed: 9892117].
9. Su BW, Heyworth BE, Protopsaltis TS, Lipton CB, Sinicropi SM, Chapman CB, et al. Basicervical versus intertrochanteric fractures: An analysis of radiographic and functional
outcomes. Orthopedics. 2006;29(10):919-25. doi: 10.3928/01477447-20061001-04. [PubMed: 17061418].
10. Desjardins AL, Roy A, Paiement G, Newman N, Pedlow F, Desloges D, et al. Unstable intertrochanteric fracture of the femur. A prospective randomised study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br. 1993;75(3):445-7. [PubMed: 8496218].
11. CONSORT Transparent Reporting of Trails. CONSORT 2010 Flow Diagram [Online]. [cited 2010]; Available from: URL: http://www.consort-statement.org/download/Media/Default/Downloads/CONSORT %202010%20Flow%20Diagram.doc
12. Levy RN, Siegel M, Sedlin ED, Siffert RS. Complications of Ender-pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip. J Bone Joint Surg Am. 1983;65(1):66-9. [PubMed: 6848537].
13. Koval KJ, Cantu RV. Intertrochanteric fractures. In: Rockwood CA, Bucholz RW, Heckman JD, Court-Brown CM, Koval KJ, Tornetta P, et al., Editors. Rockwood and green's fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. p. 1793-825.
14. Bergman GD, Winquist RA, Mayo KA, Hansen ST Jr. Subtrochanteric fracture of the femur. Fixation using the Zickel nail. J Bone Joint Surg Am. 1987;69(7):1032-40. [PubMed: 3654694].
15. Sinno K, Sakr M, Girard J, Khatib H. The effectiveness of primary bipolar arthroplasty in treatment of unstable
intertrochanteric fractures in elderly patients. N Am J Med Sci. 2010;2(12):561-8. doi: 10.4297/najms.2010.2561. [PubMed: 22558568]. [PubMed Central: PMC3338223].
16. Hassankhani EG, Omidi-Kashani F, Hajitaghi H, Hassankhani GG. How to treat the complex unstable intertrochanteric fractures in elderly patients? DHS or Arthroplasty. Arch Bone Jt Surg. 2014;2(3):174-9. [PubMed: 25386578]. [PubMed Central: PMC4225022].
17. Kayali C, Agus H, Ozluk S, Sanli C. Treatment for unstable intertrochanteric fractures in elderly patients: Internal fixation versus cone hemiarthroplasty. J Orthop Surg (Hong Kong). 2006;14(3):240-4. doi: 10.1177/230949900601400302. [PubMed: 17200522].
18. Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop. 2002;26(4):233-7. doi: 10.1007/s00264-002-0358-0. [PubMed: 12185526]. [PubMed Central: PMC3620945].
19. Emami M, Manafi A, Hashemi B, Nemati A, Safari S. Comparison of intertrochanteric fracture fixation with dynamic hip screw and bipolar hemiarthroplasty techniques. Arch Bone Jt Surg. 2013;1(1):14-7. [PubMed: 25207277]. [PubMed Central: PMC4151394].
20. Thakkar CJ, Thakkar S, Kathalgere RT, Kumar MN. Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures. Indian J Orthop. 2015;49(6):602-9. doi: 10.4103/0019-5413.168762. [PubMed: 26806966]. [PubMed Central: PMC4705725].
21. Singh S, Shrivastava C, Kumar S. Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur. J Clin Diagn Res. 2014;8(10):LC01-LC04. doi: 10.7860/JCDR/2014/10171.4972. [PubMed: 25478376]. [PubMed Central: PMC4253194].
22. Broos PL, Rommens PM, Geens VR, Stappaerts KH. Pertrochanteric fractures in the elderly. Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution? Acta Chir Belg. 1991;91(5):242-9. [PubMed: 1950312].
23. Weidmann E, Huggler AH. Hip prosthesis in per-trochanteric fractures. Z Unfallmed Berufskr. 1976;69(3-4):147-50. [PubMed: 1014921]. [In French].
24. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64(9):1295-306. [PubMed: 7142237].
25. Kesmezacar H, Ogut T, Bilgili MG, Gokay S, Tenekecioglu Y. Treatment of intertrochanteric femur fractures in elderly patients: Internal fixation or hemiarthroplasty. Acta Orthop Traumatol Turc. 2005;39(4):287-94. [PubMed: 16269874].
| Files | ||
| Issue | Vol 5, No 1 (2019) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v5i1.3321 | |
| Keywords | ||
| Femoral Neck Fractures; Hemiarthroplasty; Fracture Fixation | ||
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How to Cite
1.
Mousapour A, Mardanpour K, hojabrian A, Saeb M, Khabiri SS, Safari-Faramani R, Yaghoubi M, Rahimipour S, Shafiee A. A Comparison of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation of Basicervical Femoral Neck Fractures. J Orthop Spine Trauma. 2020;5(1):25-8.
