Modified Tension Band Wire Combined with Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly

Yi Zhuojun; Kang Bin

Abstract：Objective To investigate the efficacy of modified tension band wire fixation combined with bipolar hemiarthroplasty using a cementless femoral stem in the treatment of elderly patients with unstable intertrochanteric fractures.Methods A retrospective analysis was conducted on 46 elderly patients with unstable intertrochanteric fractures at the Mianyang Central Hospital from October 2020 to October 2022.The cohort included 20 males and 26 females,aged 71～93 years[mean:(79.43±5.88)years].All patients underwent modified tension band wire fixation combined with cementless femoral stem hemiarthroplasty.Surgical outcomes were evaluated using the visual analogue scale(VAS)for pain and the Harris hip score.Results The mean operative time was(46.30±11.30)mins,with an average blood loss of(181.20±56.80)mL.Patients were followed up for6～48 months[mean:(24.83±12.65)months].Postoperative Harris hip score and VAS scores showed significant improvement compared with preoperative values(P＜0.001).At the final follow-up,Harris hip score and VAS scores exhibited statistically significant differences compared to those at 3 months postoperatively(P＜0.001).According to the Harris hip score grading,outcomes were excellent in 22 cases,good in 20,and fair in 4,yielding an excellent-good rate of 91.30％.Postoperative radiographs on day 1 confirmed satisfactory prosthesis positioning in all patients,and fracture union was achieved within 3～5 months.Femoral stem subsidence was＜5 mm in all cases.At the final follow-up,no significant differences were observed in the vertical distance from the hip rotation center to the lesser trochanter,femoral offset,or leg length discrepancy compared to postoperative day 1(P＞0.05).One patient experienced posterior dislocation due to a fall 2 weeks postoperatively and underwent closed reduction with anti-rotation shoe immobilization.Eight cases had asymptomatic leg length discrepancies.Conclusion Modified tension band wire fixation combined with cementless femoral stem hemiarthroplasty is an effective treatment for elderly patients with unstable intertrochanteric fractures,demonstrating few complications and favorable clinical outcomes.