Primary Proximal femur replacement for unstable osteoporotic intertrochanteric and subtrochanteric fractures in the elderly: A retrospective case series

Background: Hip fractures usually occur in old aged patients with osteoporotic bone. Management of hip fractures in old aged patient is aimed to ambulate patient immediately and to restore the pre-operative ambulation. Proximal femur replacement is an effective treatment option in elderly patient with osteoporotic bones. It allow immediate weight bearing and early return to preoperative ambulatory status and minimizes the chances of systemic complication associated with prolong bed rest associated with internal fixation. This study is aimed to review the outcome of the patients whom underwent proximal femur replacement as primary treatment for the patient with comminuted intertrochanteric and sub trochanteric fracture. Patients and method: This is a study conducted in our university hospital which is a tertiary-care level-1 trauma center. A retrospective analysis of 21 patients who underwent proximal femur replacement for comminuted intertrochanteric and sub trochanteric fracture, age more than 60 years during the period from April 2011 to March 2018 was conducted. Data collected included: age, gender, comorbidities, mechanism of injury, type of fracture, functional outcome (calculated via Harris Hip Score) and one year mortality. Results: The mean age of the patients was 74.05(range 64-91) years, out of which 13 (61.8%) were female and 8 (38.0%) were male. The mean follow up was 32.6(8-91 months). Immediate post-operative ambulation status was full weight bearing (FWB) in 17 patients (80.9%) of the patients while three patients (19.0%) had non-weight bearing (NWB) due to associated co-morbidities. The mean preoperative Harris Hip score was 68.0, while the mean postoperative Harris Hip score was 66.5 at last follow up. Post operatively one patient (4.7%) developed pulmonary embolism, one patient developed dislocation. One patent (4.7%) died of sepsis from implant infection at 8 months after surgery Conclusion: Primary Proximal femoral replacement in a viable option in old aged patients with poor bone quality who developed intertrochanteric and subtrochanteric fracture. According to our study, with mortality rate comparable to that of primary fixation, yet with the added advantage of immediate post op ambulation and reduced incidences of decubitus ulcers, atelectasis and DVT.