title: Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients.
abstract: BACKGROUND
  The optimal treatment for unstable intertrochanteric fractures in elderly patients remains controversial. We aimed to compare internal fixation and bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients.
  
  
  METHODS
  124 patients aged over 70 years were enrolled into this study (64 internal fixations, 60 bipolar hemiarthroplasties). Patients were followed for two years, and had a clinical, radiological, and functional review at three, six, and twelve months as well as two years.
  
  
  RESULTS
  In the internal fixation group, the fracture reduction and internal fixation were regarded as satisfactory in 44 cases and unsatisfactory in 20 cases. Five patients in the internal fixation group (two with satisfactory results and three with unsatisfactory results) and three patients in the arthroplasty group died before the final two-year follow-up. Five patients in the internal fixation group who had unsatisfactory results suffered complications. At 24 months post-operation, patients who were treated satisfactorily with internal fixation had higher Harris scores, less pain, and better walking ability than those treated with hemiarthroplasty and unsatisfactory internal fixation.
  
  
  CONCLUSIONS
  Internal fixation with good reduction and fixation quality should be the preferred therapeutic method for elderly unstable intertrochanteric fractures, even when severe osteoporosis is present.
authors.affiliation: Department of Orthopaedic Surgery, Affiliated Suzhou Hospital, Nanjing Medical University, Suzhou Municipal Hospital, 26, Daoqian Street, Suzhou 215002, Jiangsu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Shen
authors.forename: Dong-Lai
authors.initials: DL
authors.lastname: Wang
authors.forename: Guang-Xiang
authors.initials: GX
authors.lastname: Chen
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Min-Xiang
authors.initials: MX
authors.lastname: Wei
authors.forename: Xiao-Qiang
authors.initials: XQ
authors.lastname: Cai
authors.forename: Zhao-Heng
authors.initials: ZH
authors.lastname: Yu
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: Xiang-Xin
authors.initials: XX
authors.lastname: Zhang
authors.forename: Tian-Ming
authors.initials: TM
authors.lastname: Zou
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D062785:Hemiarthroplasty; D006620:Hip Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D020127:Recovery of Function; D016896:Treatment Outcome; D016138:Walking; D016474:Weight-Bearing