title: Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures.
abstract: BACKGROUND
  The sliding screw-plate devices and cephalo-medullary nail devices have performed well in stable inter-trochanteric fractures in patients with reasonably good quality of bone. However, their suboptimal performance in comminuted fractures in the presence of osteoporotic bone has prompted many surgeons to consider bipolar hemiarthroplasty as the primary modality of management of comminuted inter-trochanteric fractures in elderly patients. However, long term stability of the hemiarthroplasty implant also may be compromised due to the presence of postero-medial bone loss at the area of the calcar.
  
  
  METHODS
  We have presented a simple and effective technique of calcar grafting by harvesting cortical bone strut from the neck of the fractured femur. A total of 34 patients with inter-trochanteric fractures of the femur were treated with calcar grafting. The mean age was 79.2 years. The graft was harvested from the calcar region of the head and neck fragment of the femur and wedged between the medial femoral cortex and medial edge of the prosthesis. The mean followup period was 54.5 months.
  
  
  RESULTS
  In 32 of 34 (94%) patients in our series, the calcar graft healed well without dislodgement. There was graft resorption in two patients associated with subsidence of the implant and loosening.
  
  
  CONCLUSIONS
  Calcar grafting using this technique provides stability to the implant in the presence of comminution and incorporates well in the majority of patients. Donor site morbidity of graft harvesting is also avoided.
authors.affiliation: Department of Orthopaedics, Breach Candy Hospital, Mumbai, Maharashtra, India.
authors.forename: Chandrashekar J
authors.initials: CJ
authors.lastname: Thakkar
authors.affiliation: Department of Orthopaedics, Johns Hopkins Hospital, Baltimore, USA.
authors.forename: Savyasachi
authors.initials: S
authors.lastname: Thakkar
authors.affiliation: Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India.
authors.forename: Rajshekhar T
authors.initials: RT
authors.lastname: Kathalgere
authors.affiliation: Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India.
authors.forename: Malhar N
authors.initials: MN
authors.lastname: Kumar
keywords: Bipolar hemiarthroplasty; Grafts; arthroplasty; calcar grafting; hip fractures; inter trochanteric fractures; intertrochanteric fractures; proximal femoral nailing; sliding screw and plate