[Treatment of intertrochanteric comminuted fracture in aged patients by replacement of artificial long-stem bipolar femoral head].

OBJECTIVE: To discuss the clinical effect of hip arthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients.

METHODS: From February 2004 to March 2006, 89 cases with intertrochanteric comminuted fractures were treated by replacement of artificial long-stem bipolar hip hemiarthroplasty with bone cement, including 34 males and 55 females, with the average age of 82.6 years (ranging from 70 years to 92 years). There were fresh fractures in 76 cases and old fractures in 13 cases. According to improving-classification of Evans-Jensen, there were 32 cases with type III fracture and 57 with type IV. Osteoporosis was graded by Singh-index, and there were 24 cases with level IV, 46 with level III and 19 with level II. The operation was delayed from 4 days to 36 days (6.5 days on average) after the injury.

RESULTS: The surgery time lasted from 50 minutes to 70 minutes (62 minutes on average). Bleeding volume was from 100 mL to 250 mL (150 mL on average). The time in hospital was from 16 days to 25 days (18.6 days on average). All incision primarily healed except 1 case which delayed union by revision with infection. Steel wire rupture occurred in 1 case, invalidation in 1 case. They were not treated because there were no uncomfortable symptoms. The consciousness disability happened in 2 cases 2 to 3 days after the operation, 2 case with the infection for the system of urine and breath 1 week after operation, were healed through the treatment. Eighty-five cases were followed up for 14 months to 39 months (26.5 months on average). The function of the hip was graded by the system of Harris and the choiceness rate was 84.7% (excellent in 16 cases, good in 56 cases, fair in 12 cases and poor in 1 case).

CONCLUSION: The treatment of intertrochanteric comminuted fracture in the aged patients by replacement of long-stem bipolar femoral head prosthesis is effective, but indications and techniques of the operation must be paid much attention to.