Background: Unstable intertrochanteric fractures in elderly patients
are associated with a high rate of complications. The purpose of this
investigation was to compare the results of long-stem cementless
calcar-replacement hemiarthroplasty with those of treatment with a proximal
femoral nail for unstable intertrochanteric fractures in elderly patients.
Methods: Fifty-eight elderly patients with an AO/OTA type 31-A2
intertrochanteric fracture of the femur were randomized into two treatment
groups and were followed for a minimum of two years. The twenty-nine patients
in Group I were treated with a long-stem cementless calcar-replacement
prosthesis, and the twenty-nine patients in Group II were treated with a
proximal femoral nail. The two treatment groups were comparable with regard to
demographic and injury variables.
Results: There were no significant differences between the groups in
terms of functional outcomes, hospital stay, time to weight-bearing, or
general complications. Patients treated with a proximal femoral nail had a
shorter operative time, less blood loss, fewer units of blood transfused, a
lower mortality rate, and lower hospital costs compared with those treated
with the long-stem cementless calcar-replacement prosthesis.
Conclusions: In elderly patients with an unstable intertrochanteric
femoral fracture, a proximal femoral nail provides superior clinical outcomes
but no advantage with regard to functional outcome when compared with a
long-stem cementless calcar-replacement arthroplasty.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.