Bipolar versus fixed head hip arthroplasty for femoral neck fractures in elderly patients

Between 2002 and 2006, fifty elderly patients with displaced femoral neck fractures were treated with hip replacement at Emergency Hospital Mansoura University. Patients were randomly selected with 25 patients had either cemented or cementless bipolar prosthesis and another 25 patients had either cemented or cementless fixed head prosthesis. There were 34 females and 16 males with an average age of 63.5 years [range between 55 - 72 years]. All patients were followed up both clinically and radiologically for an average follow up period 4.4 years [range between 2-6 years]. At the final follow up, the average Harris hip score among the bipolar group was 92 points [range between 72-97 points], while the fixed head group was 84 points [range between 65 - 95 points]. Radiologically, joint space narrowing more than 2 mm was found in only 8% [2 patients] among the bipolar group, and in 28% [7 patients] of the fixed head group. Through the follow up period, total hip replacement was needed in 2 cases of the bipolar group and 7 cases of the fixed head group. Bipolar hemiarthroplasty offer a better range of movement with less pain and more stability than the fixed head hemiarthroplasty in elderly patients with displaced femoral neck fractures regardless to the cost factor

modified ring fixator device in the treatment of intertrochanteric femoral fractures under local anaesthesia

In 19 high-risk patients intertrochanteric fractures were treated with a case by case pre-operatively assembled ring fixator according to the patient's own neck shaft angle of the healthy side under local anaesthesia. in the Orthopaedic Surgery Department of Mansoura University Hospital between January 2005 and July 2006. They were selected because of their high surgical or anaesthetic risk, and evaluated by radiographs immediately after operation. and at 3 week interval follow up visits, there was early lost follow up for one death due to medical causes unrelated to the surgical procedure. A short intraoperative time [25 minutes], no need for blood transfusion. fast ambulation and an average hospitalization of 3 days. were noted. All fractures healed within 17 weeks. 'All patients had a superficial pin tract infection but deep one was seen in one patient [5%]. and in 3 patients the fracture united with a limb shortening of 15 mm [10-20 mm]. No implant failures or limitation of knee movements were recorded. There were 16 good results, two acceptable and one poor result at final follow up. This multi-planner ring fixator can be used successfully for the treatment of elderly high-risk patients with intertrochantertc fractures providing satisfactory stability and early weight-bearing