Effect of Lesser Trochanter Fixation on Functional Outcomes Following Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients: A Retrospective Cohort Study.

BACKGROUND

The necessity of lesser trochanter (LT) fixation during hemiarthroplasty for unstable intertrochanteric fractures in the elderly remains controversial. This study aimed to determine whether LT fixation influences functional recovery and clinical outcomes.

METHODS

We retrospectively analyzed 105 patients (aged ≥ 65 years) who underwent cementless hemiarthroplasty for unstable intertrochanteric fractures with displaced LT fragments. Patients were divided into Fixation (n = 33) and Non-fixation (n = 72) groups. The primary outcome was the Harris Hip Score (HHS) at 12 months. Secondary outcomes included operative time, blood loss, limb length discrepancy, hip flexor strength, and complications.

RESULTS

Mean Harris Hip Score (HHS) at 12 months did not significantly differ between the non-fixation and fixation groups (83.1 ± 12.1 vs 85.2 ± 6.9; mean difference, -2.1 points; p = 0.477). Incidence of hip flexor weakness was also similar (20.8% vs 9.1%; p = 0.171). Multivariate analysis showed that LT fixation was not an independent predictor of postoperative HHS (β = 2.53; 95% CI, -3.61 to 8.67; p = 0.413). However, the non-fixation group had significantly shorter operative times (124.7 ± 14.9 vs 134.0 ± 15.1 min; p = 0.004). Blood loss and complication rates were comparable between groups.

CONCLUSION

In this retrospective cohort, routine anatomical fixation of a displaced LT during hemiarthroplasty was not associated with superior functional recovery in elderly patients with unstable intertrochanteric fractures. Omitting fixation shortened operative time without an observed increase in complications, suggesting that non-fixation may be a reasonable operative simplification in selected patients.