Comparison of functional outcomes of osteosynthesis and hemiarthroplasty in the treatment of intertrochanteric femur fracture

Aim: We aimed to compare the functional outcomes of intramedullary or extramedullary osteosynhtesis with hemiartroplasty in the treatment of intertrochanteric femur fracture in patients older than 65 years.Material and Method: Between 2006-2011 in Bezm-i Âlem Vakıf University Hospital and between 2009-2011 in Dr. Lütfi Kırdar Kartal Research and Training Hospital, a total of 60 patients with three groups of 20 intertrochanteric femur fracture cases treated with either dynamic hip screw or proximal femoral nail and hemiarthroplasty were included in the study.Demographic data, both physical and radiological examination and functional scoring were noted in retrospective fashion. Functional status was assessed with Harris, Merle d?Aubigne and SF-36 scores. Statistical anaylsis was done with ANOVA, chi-square tests and nonparametrical corelation tests were used. Functional outcomes were compared among three groups. Relationship between demographic data and functional outcome was assessed.Results: Mean age was 75,9 (35 Female, 25 Male). Mean follow up was 21,4 months. Average Harris hip scores were 66,07 in dynamic hip screw group, 74,73 in proximal femoral nail group, and 64,45 in hemiarthroplasty group. Mean Merle d?Aubigne scores were (12,15), (2,90), and (12,30), respectively. Average SF-36 scores were (pcs: 34,81, mcs: 43,95), (40,46/42,87), and (37,26/40,33), respectively. No statistically significant difference were noted in comparison of functional scores of groups. Nevertheless, proximal femoral nail group had higher functional scores. A negative corelation was detected between age and Harris hip score in dynamic hip screw group. Any statistical significance was not noted for bone quality, fracture type and stability, and follow up time in comparison with functional outcomes.Discussion and Conclusion: Surgical treatment is superior to conservative therapy in intertrochanteric femur fractures due to complications. Superiority in surgical treatment options is frequently investigated in the literature, but it?s still controversial. Functional scores of our study were under the national average, but results were favorable with the literature. We consider that well assessment of patients age, comorbidity, functional and socioeconomical status is necessary in desicion of surgical treatment option. We believe that further randomised prospective investigations will be better if podographic analysis is added to current functional scorring systems.