TREATMENT OF UNSTABLE PERITROCHANTERIC FRACTURES IN ELDERLY PATIENTS WITH A COMPRESSION HIP SCREW OR WITH THE VANDEPUTTE (VDP) ENDOPROSTHESIS - A PROSPECTIVE RANDOMIZED STUDY

A prospective randomized study was set up, comparing a compression hip screw with the Vandeputte (VDP) endoprosthesis treatment for fresh, u nstable peritrochanteric fractures, according to the Evans-Jensen and AO systems. Ninety patients, ages greater than or equal to 70 years, 4 7 of whom were treated with a compression hip screw and 43 with a VDP endoprosthesis, were included. All patients were being followed for 3 months. No difference between the two groups was found for operating t ime, wound complications, and mortality rate, but there was a higher t ransfusion need in VDP treatment. Severe fracture redisplacement or to tal collapse of the fracture occurred in 11 (26%) compression hip scre w patients, two of whom had revision surgery. Only one patient needed reintervention after VDP treatment. Functional capacity of preoperativ e independent patients at hospital discharge did not differ for the tw o groups. In conclusion, the compression hip screw seemed to be an app ropriate implant for most of the peritrochanteric fractures, but for v ery old patients with advanced osteoporosis, with a complex, unstable peritrochanteric fracture, and who are eligible for early mobilization , primary cemented endoprosthesis might be the best treatment.