Treatment of instable intertrochanteric femur fractures: comparison of clinical efficacy and treatment costs of bipolar hemiarthroplasty and proximal femoral nail

The aim of the present study was to compare the cost and effectiveness of bipolar hemiarthroplasty (PBH) and proximal femoral nail (PFN) in the management of instable intertrochanteric femur fractures (ITFF) in geriatric population. A total of 51 patients who were surgically treated for ITFF were included in the study. Group A was treated with PFN (n = 26), while group B was treated with BPH (n = 25) during the same period. Clinical effectiveness was evaluated via Harris Hip Score (HHS) and Visual Analog Scale (VAS) at baseline and 12-month follow-ups. Duration of surgery, amount of blood needed for transfusion, number of patients requiring transfusion, one-year mortality and re-operation rates, time needed for full weight bearing, number of fluoroscopy scans, hospital costs and complications were recorded and compared between groups. VAS and HHS scores of both groups were significantly improved compared to pretreatment values (p < 0.001). VAS and HHS scores of PFN group were significantly higher than those of BPH group at the last follow-up (p < 0.001 and p < 0.001, respectively). Mean operation time was significantly higher in BPH group (p < 0.001). Percentage of patients requiring transfusion and the amount of blood needed for transfusion were significantly higher in BPH group (p = 0.002 and p = 0.001, respectively). One-year mortality rate in BPH group was almost twice that of the PFN group, and reoperation rate in BPH group was almost three times that of the PFN group. Time needed to full weight bearing was significantly lower in BPH compared to PFN group (p = 0.001). Number of fluoroscopy scans was significantly higher in PFN than that in BPH group (p < 0.001). There was no significant difference between hospital costs in groups (p = 0.096). Both PFN and BPH methods are efficacious in treating instable intertrochanteric femur fractures. However, PFN has advantages of shorter skin incision, less transfusion need, higher clinical efficacy and less mortality, while BPH offers advantages of early mobilization and less radiation exposure.