TREATMENT OF FEMORAL NECK FRACTURES BY BIPOLAR HEMIARTHROPLASTY THROUGH SHORT EXTERNAL ROTATOR PRESERVING MIS APPROACH IN PATIENTS WITH NEUROLOGIC DISORDERS

Abstract

We developed a modified posterior approach that preserved the short external rotator muscles to prevent dislocation after THA or BHA. The present study aimed to evaluate the effectiveness of short external rotator preserving posterior(ERP) approach for bipolar hemiarthroplasty in treatment of femoral neck fractures in patients with neurologic disorders. Between March 2004 and February 2006, we performed 187 cementless bipolar hemiarthroplasties for displaced femoral neck fractures on 36 patients with neurologic disorders, who were operated on by ERP approach (Group 1) and 151 patients without neurologic deficits, who were operated on by conventional posterolateral approach (Group 2). We compared operation time, the amount of postoperative blood loss, the early postoperative complication rates, the dislocation rate within 1 year, and duration of hospital stay between two groups.

The amount of postoperative blood loss was significantly decreased in group 1(p < 0.01). There were no significant differences in mean operation time and early postoperative complication rate including wound problem, deep vein thrombosis or infection and duration of hospital stay. There was no dislocation after operation in group 1, but seven patient (4.6%) had dislocation in group 2. Nine patients (25.0%) died within postoperative 1 year in group 1 and twenty six patients (17.2%) died in group 2.

Cementless bipolar hemiarthroplasty through ERP approach provides a favorable outcome for treatment of displaced femoral neck fracture in patients with neurologic disorders who is considered as high risk of dislocation. Also, it decreases the postoperative blood loss and the needs of postoperative abduction brace.