Treatment for unstable intertrochanteric fractures in elderly patients: internal fixation versus cone hemiarthroplasty.

PURPOSE To evaluate the effectiveness of internal fixation versus cone hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. METHODS The choice of treatment was based on the year of admission: between 2001 and 2003, 42 patients (mean age, 73 years) underwent cone hemiarthroplasty using a cementless press fit through a posterior approach, whereas between 1999 and 2001, 45 patients (mean age, 75 years) underwent internal fixation using a dynamic hip screw through a lateral approach in a supine position. Patients with stable fractures with intact lesser trochanter, immobility before injury, age younger than 60 years, or with associated injuries (such as another fracture) were excluded. Patients were encouraged active rehabilitation in bed. Bony union was determined by clinical and radiological examinations. Patients were followed up at 6-week intervals in the first sixth months and every 3 months thereafter until bony union was achieved. In the final follow-up, 32 cone hemiarthroplasty patients and 38 internal fixation patients were available for evaluation according to Merle d'Aubigne and Postel criteria. RESULTS There were no significant differences between the 2 groups in terms of sex, age, fracture type, Singh index, follow-up period, hospital stay, operating time, and receipt of blood transfusions. Clinical results of both groups were similar. Hemiarthroplasty patients were allowed full weight bearing significantly earlier than the internal fixation patients. CONCLUSION Cone hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilisation.