The Efficacy of a Double Wiring Technique in Cementless Hemiarthroplasty for Unstable Basicervical Intertrochanteric Fractures: A Propensity Score-Matched Analysis of Femoral Neck Fractures.

BACKGROUND

Basicervical intertrochanteric (IT) fractures are a distinct subtype of proximal femoral fractures, characterized by marked rotational instability and a high risk of fixation failure. In elderly patients, primary arthroplasty may serve as a viable option. This study aimed to report the clinical outcomes of cementless hemiarthroplasty using a double wiring technique for unstable basicervical IT fractures in elderly patients and to compare them with those after cementless hemiarthroplasty for displaced femoral neck (FN) fractures.

METHODS

We retrospectively reviewed 45 patients aged 75 years and older who received cementless bipolar hemiarthroplasty using a double wiring technique for unstable basicervical IT fractures and were followed up for more than 1 year between January 2015 and December 2022. After propensity score matching (2 : 1), the control group comprised 90 patients who underwent cementless hemiarthroplasty for displaced FN fractures. All operations were performed via a short external rotator-preserving posterolateral approach. The perioperative results, postoperative complications, and 1-year mortality of the 2 groups were investigated and compared.

RESULTS

The IT group exhibited significantly longer operation times (p = 0.031) and greater total blood transfusion volume (p = 0.027) than the FN group despite no significant differences in blood loss and transfusion rate. No significant differences were observed in postoperative medical and surgical complications. Wire breakage occurred in 7 patients, and of those, 5 showed proximal migration of the greater trochanter fragment. However, there was no subsequent functional impairment in these patients. At 1 year after the index surgery, there were no significant differences in walking ability and mortality rate between the 2 groups.

CONCLUSIONS

Cementless hemiarthroplasty with a double wiring technique for unstable basicervical IT fractures demonstrated clinical outcomes and 1-year mortality equivalent to those of hemiarthroplasty for displaced FN fractures, suggesting it as a feasible and safe option in osteoporotic elderly patients with these fractures.