OBJECTIVETo introduce bipolar hemiarthroplasty with a two-step osteotomy technique and observe its clinical result for unstable intertrochanteric fractures in senile patients.

METHODSFifteen consecutive patients with unstable intertrochanteric fractures aged from 81 to 92 years with a mean of 85 years were treated in our hospital from August 2006 to October 2011 (Evans type III in 4 cases, Evans type IV in 11 cases), who received bipolar hemiarthroplasty with a two-step osteotomy technique performed by a senior orthopedic surgeon through posterior approach under general anesthesia. All cases were evaluated by Zuckerman functional recovery score (FRS) and operative risk assessment software 1, based on the patients' physical and laboratory examinations preoperatively. The duration and blood loss have been recorded. There were 4 male cases (4 hips) and 11 female cases (11 hips). All prostheses consisted of Link SP II femoral stem and bipolar femoral head. All patients were followed up for more than 1 year.

RESULTSThe average preoperative FRS, predictive value of operative morbidity and mortality were 83.7 (81.7-85.9), 9.3% (7.3%-15.0%) and 3.5% (2.3%-4.2%), respectively. The average operation time was 50 minutes with a mean intraoperative blood loss of 310 ml. There were no operative or anesthetic complications or deaths within 30 days after operation. Sitting up was permitted 3 to 4 days, and partial weight bearing was allowed 5 to 7 days after operation. The average FRS was 79.3 at 30 days and 84.9 at 1 year postoperatively. Three patients died of unrelated causes (one due to myocardial infarction and the others due to cerebral hemorrhage during at least one-year follow-up).

CONCLUSIONBipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fractures in the senile patients is a good choice for early ambulation and good hip function.