What is the step-by-step procedure for treating an Intertrochanteric (ICNF) fracture with bipolar hemiarthroplasty?

From the Guidelines

Bipolar hemiarthroplasty is the recommended surgical procedure for treating intracapsular neck of femur (ICNF) fractures, particularly in elderly patients with limited functional demands. The procedure begins with patient positioning in the lateral decubitus or supine position, followed by surgical site preparation and draping. After administering appropriate anesthesia, such as spinal anesthesia 1, the surgeon makes an incision, typically using an anterolateral approach 1. The gluteus maximus is split along its fibers, and the short external rotators are identified and tagged for later repair. The hip joint capsule is exposed and incised to access the femoral head. The fractured femoral head is then removed using a corkscrew extractor. The acetabulum is inspected but not reamed or modified. The femoral canal is prepared by sequential reaming and broaching to the appropriate size. A trial reduction is performed to assess stability, leg length, and range of motion. Once satisfied, the surgeon implants the definitive femoral stem with cement, as recommended by the strongest evidence 1, or press-fit technique depending on bone quality. The bipolar head component is assembled and impacted onto the femoral stem. The hip is reduced, and stability is confirmed through range of motion testing. The capsule and external rotators are repaired, followed by layered closure of the wound. To decrease bleeding and the need for transfusion, tranexamic acid (TXA) should be administered at the start of the case 1. Postoperatively, patients typically begin weight-bearing as tolerated with assistive devices and undergo physical therapy for gait training and strengthening exercises.

Some key points to consider during the procedure include:

• The use of cemented femoral stem is recommended 1
• The administration of tranexamic acid (TXA) to reduce blood loss and need for transfusion 1
• The choice of anesthesia, either spinal or general, is appropriate for hip fracture patients 1
• The anterolateral approach is a recommended approach for hemiarthroplasty 1
• The procedure preserves the native acetabulum while replacing the femoral head, providing pain relief and allowing early mobilization for elderly patients with femoral neck fractures.

It is essential to follow the recommended guidelines and evidence-based practices to ensure the best possible outcomes for patients undergoing bipolar hemiarthroplasty for ICNF fractures.

From the Research

Procedure for Fracture ICNF by Bipolar Hemiarthroplasty

The procedure for fracture ICNF (intertrochanteric fracture with nonunion or failed internal fixation) by bipolar hemiarthroplasty involves several steps:

• Preoperative planning: The surgeon evaluates the patient's overall health, medical history, and the extent of the fracture to determine the best course of treatment 2, 3.
• Anesthesia and positioning: The patient is given general or regional anesthesia and positioned on the operating table in a supine or lateral position, depending on the surgeon's preference 4.
• Incision and dissection: A surgical incision is made in the hip area, and the soft tissues are dissected to expose the fractured femur and the hip joint 4.
• Removal of failed internal fixation: If the patient has a failed internal fixation, the surgeon removes the hardware and any debris or scar tissue 3.
• Preparation of the femur: The surgeon prepares the femur for the hemiarthroplasty by reaming and broaching the canal to fit the prosthetic stem 4.
• Implantation of the prosthetic: The bipolar hemiarthroplasty prosthetic is implanted, consisting of a femoral stem and a bipolar head that articulates with the acetabulum 2, 4.
• Reduction and stabilization: The surgeon reduces the fracture and stabilizes the prosthetic using cement, screws, or other fixation methods 4.
• Closure and rehabilitation: The incision is closed, and the patient is taken to the recovery room for postoperative care and rehabilitation 3, 5.

Key Considerations

Some key considerations for the procedure include:

• The choice of prosthetic and fixation method depends on the patient's age, activity level, and bone quality 2, 3.
• The surgeon must carefully evaluate the patient's overall health and medical history to determine the best course of treatment 2, 3.
• Postoperative rehabilitation is crucial to ensure proper healing and functional recovery 3, 5.
• Complications such as infection, dislocation, and loosening of the prosthetic can occur, and the surgeon must be prepared to address these issues 2, 3.

Outcomes and Complications

The outcomes and complications of bipolar hemiarthroplasty for fracture ICNF include:

• Improved functional outcomes and reduced pain compared to internal fixation alone 2, 3.
• Higher risk of complications such as infection, dislocation, and loosening of the prosthetic compared to internal fixation alone 2, 3.
• The need for revision surgery in some cases due to complications or wear and tear of the prosthetic 3, 5.
• The importance of careful patient selection and preoperative planning to minimize the risk of complications and ensure optimal outcomes 2, 3.