A Comparative Study between Outcome Measures of Coxofemoral Bypass Surgery and Osteosynthesis in Unstable Intertrochanteric Femur Fractures in the Elderly

Aims and background: To evaluate and compare the outcomes of intertrochanteric fracture, managed by osteosynthesis using proximal femur nail (PFN) and coxofemoral bypass surgery using cemented bipolar hemiarthroplasty.Materials and methods: A total of 70 patients of unstable intertrochanteric femur fractures of age more than 60 years treated with either using PFN (group I) or coxofemoral bypass surgery (group II) were recruited from a tertiary care center from July 2022 to July 2024.Patients were followed up for at least 1 year.Results: The average surgical duration for group I and group II was 74.85 13.58 and 86.57 14.64 minutes, respectively.Average blood loss in group I was 112.14 mL, and in group II was 282.85 mL.Group II had earlier weight-bearing than group I.During early follow-up, Harris's hip score was better in group II, but Harris's hip score at 6 months and 1 year was similar in both groups.Group II had significantly more complications than group I. Conclusion: Coxofemoral bypass surgery allows for early mobilization of the patient.It is a technically demanding surgery with a high incidence of complications in inexperienced hands.Osteosynthesis using PFN is the preferred modality of treatment in unstable intertrochanteric femur fractures in elderly patients due to significantly less blood loss, lesser surgical time, fewer hospital stays, and fewer complications than the coxofemoral group.Clinical significance: According to our study, for the treatment of unstable intertrochanteric fractures in the elderly, coxofemoral bypass by bipolar hemiarthroplasty is preferable to proximal femoral nail.In older patients with femur intertrochanteric fractures, the operation provided a long-term solution, enhanced quality of life, and a quicker return to preinjury levels.It also improved the Harris Hip score.