Comparative Evaluation of Functional Outcomes in Unstable Intertrochanteric Fractures Treated with Bipolar Hemiarthroplasty Versus Dynamic Hip Screw Fixation in the Elderly: A Prospective Analysis

Abstract

Background: Unstable intertrochanteric fractures in the elderly present a clinical challenge due to osteoporosis, comminution, and a high risk of post-operative complications. Early mobilization and optimal functional recovery are key goals in their management. This study compares bipolar hemiarthroplasty (BPHA) with dynamic hip screw (DHS) fixation in treating these fractures.
Objective: To analyse and compare the short-term clinical, radiological, and functional outcomes in elderly patients with unstable intertrochanteric fractures treated with BPHA and DHS.
Methods: This prospective study included 40 patients aged 56–75 years with AO Type A2 intertrochanteric fractures treated at a tertiary care hospital from March 2017 to October 2018. Patients were randomly assigned to two groups: BPHA (Group A, n=20) and DHS fixation (Group B, n=20). All patients were evaluated using the Harris Hip Score (HHS) at 9 months post-operatively. Data on intraoperative blood loss, operative time, complications, transfusion requirements, and hospital stay were recorded.
Results: Group A had significantly lower blood loss (mean: 111 mL vs. 148 mL, p=0.031), fewer transfusions (mean units: 1.4 vs. 1.9, p=0.0276), and a shorter hospital stay (14.7 vs. 18.9 days, p=0.032). Functional outcomes were superior in Group A, with HHS at 9 months averaging 89.66 compared to 77.66 in Group B (p=0.046). The BPHA group experienced fewer complications (10%) versus the DHS group (20%).
Conclusion: Bipolar hemiarthroplasty provides better functional outcomes, fewer complications, and facilitates early mobilization in elderly patients with unstable intertrochanteric fractures compared to DHS fixation.