title: Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly.
abstract: BACKGROUND
  The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment.
  
  
  METHODS
  Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit.
  
  
  RESULTS
  The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed.
  
  
  CONCLUSIONS
  Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.
authors.affiliation: Orthopaedics and Traumatology Department, Private Ortopedia Hospital, Adana, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Celiktas
authors.affiliation: Orthopaedics and Traumatology Department, Private Ortopedia Hospital, Adana, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Togrul
authors.affiliation: Orthopaedics and Traumatology Department, Antalya Training and Research Hospital, Antalya, Turkey.
authors.forename: Ozkan
authors.initials: O
authors.lastname: Kose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000379:methods*; D006615:Hip / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography
keywords: Hemiarthroplasty; Hip fractures; Weight-bearing