Yakup Ekinci1,2,3,4, Kaan Gürbüz1,2, Sabri Batın1,2,5, Murat Kahraman2,6, Fatih Doğar1,6,7, Zeliha Kaya Erten8

1Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
2Department of Orthopedics and Traumatology, Kayseri City Training and Research Hospital, Kayseri, Turkey
3Department of Orthopedics and Traumatology, Başkale Public Hospital, Van, Turkey
4Department of Orthopedics and Traumatology, Develi State Hospital, Kayseri, Turkey
5Department of Orthopedics and Traumatology, Batman State Hospital, Turkey
6Department of Orthopedics and Traumatology, Necip Fazıl State Hospital, Kahramanmaraş, Turkey
7Department of Orthopedics and Traumatology, Sütçü İmam University Hospital, Kahramanmaraş, Turkey
8Department of Nursing, Health Sciences Faculty, Nuh Naci Yazgan University, Kayseri, Turkey

Keywords: Harris Hip Score, hemiarthroplasty, intertrochanteric fracture, proximal femur nail.


Objectives: This study aims to compare the clinical and functional results of intertrochanteric femoral fractures treated with bipolar hemiarthroplasty (BHA) or proximal femoral nailing (PFN) in elderly patients.

Patients and methods: This multicenter, prospectively followed-up, retrospectively compared cohort-type study included 308 patients (81 males, 227 females; mean age 78.4±7.2 years; range, 65 to 95 years) who were treated with BHA or PFN for intertrochanteric fractures by five orthopedic surgeons in four provinces and seven clinics between January 2014 and May 2018. Clinical follow-up was performed at third week, third and sixth months, and at the end of the first and second years. The American Society of Anesthesiologists for preoperative status, Singh index for bone quality, and Harris Hip Score (HHS) for functional outcomes were evaluated.

Results: While 156 patients (38 males, 118 females; mean age 77.7±5.9) were treated with BHA, 152 patients (43 males, 109 females; mean age 79±6.1) were treated with PFN. While there was no significant difference between the two groups in terms of total HHS, a significant difference was found in the sub-parameters (p<0.001). Good and excellent results were found in 78.2% of BHA and 86.2% of PFN patients. Mortality rates were similar at the end of two years (14% and 13.6%, respectively).

Conclusion: In general, clinical and functional outcomes of BHA and PFN are similar. The rates of pulmonary embolism and deep vein thrombosis are significantly higher in BHA. However, BHA is advantageous in terms of operation time and early weight bearing compared to PFN.

Citation: Ekinci Y, Gürbüz K, Batın S, Kahraman M, Doğar F, Kaya Erten Z. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing. Jt Dis Relat Surg 2020;31(2):209-217.

This study was orally presented at the 29th Turkish National Congress of Orthopaedics and Traumatology in Antalya on 22-27 October 2019, Antalya, Turkey.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.