• Jun Shen, Dong-Lai Wang, Guang-Xiang Chen, Hui-Lin Yang, Li Li, Min-Xiang Wei, Xiao-Qiang Cai, Zhao-Heng Yu, Liang Cheng, Xiang-Xin Zhang, and Tian-Ming Zou.
• Department of Orthopaedic Surgery, Affiliated Suzhou Hospital, Nanjing Medical University, Suzhou Municipal Hospital, 26, Daoqian Street, Suzhou 215002, Jiangsu, China.
• J Orthop Sci. 2012 Nov 1; 17 (6): 722-9.

BackgroundThe optimal treatment for unstable intertrochanteric fractures in elderly patients remains controversial. We aimed to compare internal fixation and bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients.Methods124 patients aged over 70 years were enrolled into this study (64 internal fixations, 60 bipolar hemiarthroplasties). Patients were followed for two years, and had a clinical, radiological, and functional review at three, six, and twelve months as well as two years.ResultsIn the internal fixation group, the fracture reduction and internal fixation were regarded as satisfactory in 44 cases and unsatisfactory in 20 cases. Five patients in the internal fixation group (two with satisfactory results and three with unsatisfactory results) and three patients in the arthroplasty group died before the final two-year follow-up. Five patients in the internal fixation group who had unsatisfactory results suffered complications. At 24 months post-operation, patients who were treated satisfactorily with internal fixation had higher Harris scores, less pain, and better walking ability than those treated with hemiarthroplasty and unsatisfactory internal fixation.ConclusionsInternal fixation with good reduction and fixation quality should be the preferred therapeutic method for elderly unstable intertrochanteric fractures, even when severe osteoporosis is present.

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