title: Intra-operative fractures in cementless bipolar hemiarthroplasty.
abstract: OBJECTIVE
  To compare patients with or without intra-operative fracture during cementless bipolar hemiarthroplasty.
  
  
  METHODS
  Records of 76 men and 202 women who underwent cementless bipolar hemiarthroplasty for femoral neck fractures were reviewed. Patients with and without intra-operative fractures and patients with different types of intra-operative fractures were compared.
  
  
  RESULTS
  Two men and 22 women aged 62 to 93 (mean, 80) years sustained intra-operative fractures at the lesser trochanter (n=18), the greater trochanter (n=5), and the subtrochanter (n=1). All 18 lesser trochanteric fractures and 4 of the greater trochanteric fractures were recognised intra-operatively and managed with cerclage wiring (n=21) or conversion to cemented hemiarthroplasty with cerclage wiring (n=1). The remaining 2 fractures were recognised postoperatively on radiographs and managed conservatively or with revision surgery and cerclage wiring and plating on day 4. Intra-operative fractures correlated with female gender (p=0.03) and operative delay to optimise patients (p=0.02), whereas the fracture site correlated with the time of fracture recognition (p=0.01). Postoperatively, 5 patients were allowed partial weight bearing and 18 were instructed to mobilise with a wheelchair for at least 6 weeks. One patient died from an unrelated cause. At one year, 21 patients reported no hip pain and 2 reported minimal pain. 17 could walk with or without aids and 6 were wheelchair-bound.
  
  
  CONCLUSIONS
  Surgeons should be familiar with the size difference in trial and actual implants used in bipolar hemiarthroplasty in order to better estimate the extent of broaching required. In most patients with an intra-operative fracture, the one-year outcome was not compromised, despite the poorer short-term outcome.
authors: Department of Orthopaedic Surgery, Changi General Hospital, Singapore.
authors: Chung-Liang
authors: CL
authors: Kuo
authors: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Si Heng Sharon
authors: SH
authors: Tan
authors: Department of Orthopaedic Surgery, Changi General Hospital, Singapore.
authors: Haw Chou
authors: HC
authors: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005269:Femur / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D062785:Hemiarthroplasty / Q000009:adverse effects*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome
keywords: hemiarthroplasty; intraoperative complications