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NBE CME programme for DNB consultantsOrthopedicsA Comparative Study of Bipolar Prosthesis With Austin Moore Prosthesis In The Treatment OfDisplaced Femoral Neck Fractures In ElderlyAims & objectives-To compare the results of Bipolar Prosthesis with Austin Moore Prosthesis inthe treatment of displaced femoral neck fractures in elderly.This study is designed to determinewhether there are any significant differences at a minimum period in‣ the rate of prosthetic dislocation‣ post operative medical and wound complications‣ need for revision surgery‣ incidence of hip pain‣ recovery of preinjury levels of ambulatory status‣ activities of daily livingIntroduction-Fracture neck of femur is one of the commonest injuries causing morbidity andmortality in patients of geriatric age group. With improvement in standards of health and longevity,this fracture is being increasingly encountered. Fractures of femoral neck have always presentedgreat challenges to orthopaedic surgeons and remain in many ways today the unsolved fractureas far as treatment and results are concerned.Even the current emphasis on Osteoporosis aimsfinally to decrease the incidence of this fracture as this is the fracture with the greatest risk toindependent ambulation. With due care and precise surgery these difficult fractures can besuccessfully treated.Prostheses for the femoral head became popular soon after their introductionbecause they offered a solution, at least in part, to several troublesome problems in hip surgery.Hemiarthroplasty using either Bipolar or Austin Moore prosthesis has been advocated as the besttreatment in displaced femoral neck fractures in elderly, for early rehabitation, by permitting earlymobilization and preventing the dreaded complications of non-union and avascular necrosis.Review of literature‣ Unipolar versus bipolar Hemiarthroplasty : Functional outcome after femoral neck fracturesat a minimum of 36 months of follow up.Journal of Orthopaedic Trauma 16(5) : 317-322,May 2002.Org. Barnard, C. et al.‣ Functional ability was compared between both groups with regard to recovery of ambulatorystatus and activities of daily living as well as the incidence of hip pain at a minimum of 36months of fracture follow up. No significant differences were found between the unipolargroups.‣ Unipolar or Bipolar Prosthesis for the displaced intracapsular hip fracture?An unansweredquestion. Clinical Orthopaedics and related research (353) : 81-85, August,1998.Gilbert, Marvin, S.M.D. : Cupozzi, James, M.D.,Modular prostheses were developedto address the problems of loosening, cartilage wear and protrusion which were seenwith single unit endoprostheses. Modular Unipolar prostheses address many of theseproblems and are significantly less expensive than the Bipolar prosthesis.‣ A survey of the treatment of displaced intracapsular femoral neck fractures in theU.K.Crossman PT. et al‣ Department of Trauma and Orthopaedic Surgery, Luton and Dunstable Hospital, U.K. PaulCrossman@beeb.net. A survey was undertaken to investigate the treatment of displacedintracapsular femoral neck fractures across the U.K. The usual practice at 223 Hospitalwas recorded for 2 groups of patients, active and frail. For frail patients, Hemiarthroplastywith an Austin Moore or Thompson prostheses was undertaken at 94% of hospitals, bipolarprostheses were used at 8% and internal fixation was undertaken at 1%.164
NBE CME programme for DNB consultantsInclusion criteria‣ Community and Household ambulators.‣ More than 65 years of age.‣ Displaced femoral neck fractures.Exclusion criteria‣ Non AmbulatorsMaterials and methods- This study will be conducted in Department of Orthopaedics, GovernmentGeneral Hospital, Pondicherry between August 2005 to August 2006. The facilities, expertise andthe necessary infrastructure are available in this hospital.Group-I, Bipolar Prosthesis-It consists of a metallic acetabular cup and a polyethylene liner withsnap fit socket to be used with a femoral prosthesis with a 22 or 32 mm diameter head. It has gotinner and outer bearing.Available in various sizes:Approach-Posterior or Lateral.Methods-As per the manufacturer’s manual.Group-II, Austin Moore Prosthesis-It is a fixed stem prosthesis.Available in various sizesApproach-posterior (or) lateralMethod‣ Capsulotomy exposes the fracture site.‣ Head extracted and measured.‣ Acetabulam packed during reaming.‣ A notch made in the posterosuperior portion of the neck to maintain anteversion of 10-15 0‣ Prosthesis inserted into the canal to seat well over the calcar.‣ Reduction achieved by gentle traction‣ Wound closed over a negative suction drain/no drain.Partial weight hearing started on the 2 nd post operative day depending on the general conditionof the patient in both the groups.Statistical methods -Analysis will be by students ‘t’ test, chi square tests and fisher’s exacttests and the results computed.Department involved‣ Deparment of Orthopaedics, Government General Hospital, Pondicherry.‣ Department of Anaesthesia, Government General Hospital, Pondicherry.‣ Department of Geriatric Medicine, Government General Hospital, Pondicherry.165
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