Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty

Objectives: There is no consensus as to whether internal fix¬ation or hemiarthroplasty is more appropriate for the treatment of intertrochanteric femur fractures in elderly patients. While the latter offers early mobilization, internal fixation preserves the hip joint and avoids long-term complications associated with the prosthesis. This retrospective study aimed to compare the early results of these treatment modalities. Methods: The study included 81 patients who were available for follow-up after surgery for intertrochanteric femur fractures. Of 38 patients (mean age 77.7 years; range 65 to 99 years) treated with internal fixation, 25 were alive; of 43 patients (mean age 80 years; range 67 to 97 years) treated with hemiarthroplasty, 22 were alive at the last follow-ups. The two groups were compared with regard to perioperative characteristics, mobilization time, complications, mortality, and daily activities according to the Barthel Activities of Daily Living Index. The mean follow-up was 22.7 months (range 6 to 39 months) in internal fixation, and 22.3 months (range 7 to 39 months) in hemiarthroplasty groups. Results: Subsequent to the operation, mortality occurred in 34.2% after a mean of 13 months (range 1 to 36 months) and in 48.8% after a mean of six months (range 1 to 24 months) in patients treated with internal fixation and endoprosthesis, respectively. There were no significant differences with respect to mobilization in bed, standing, weight bearing without sup¬port, complications, and daily activity scores. The only signifi¬cant difference in favor of hemiarthroplasty was that full weight bearing with two crutches took a shorter time (p<0.05). Conclusion: Short-term results suggest that hemiarthroplasty is not an advantageous alternative to internal fixation; more¬over, its postoperative survival is shorter and mortality rate is higher. Osteosynthesis seems to be the first choice in the treat¬ment of elderly patients with intertrochanteric femur fractures.