Is internal fixation of the intertrochanteric fractures reliable option in patients with cognitive dysfunction?

The purpose of this study was to compare the results of hemiarthroplasty with those of treatment internal fixation devices for stable intertrochanteric fractures in patients with moderate and severe cognitive dysfunction. 155 patients were evaluated retrospectively. 54 patients were treated with proximal femoral nail (PFN), 57 with dynamic hip screw (DHS) and 44 were underwent hemiarthroplasty (HA). Activities of daily living (ADL) were evaluated with the Barthel Activity Index (BI) score and the Health Related Quality of Life (HRQoL) with the Euroquol-5D (EQ-5D) test. The BI scores in HA patients were found to be at significantly high compared to the PFN and DHS groups both at the one and two years. A significant difference was also found in the EQ-5D scores in favor of HA group at one year. The most common complications in internal fixation patients were malunion (7/54 for PFN, 9/57 for DHS group), fixation failure (8/54 for PFN, 12/57 for DHS group) and dislocation (10/44), deep infection (8/44) for HA group. The strong predictive variables on ADL in dementia patients were, duration time to surgery and pre-operative MMSE score. In conclusion, HA is the prefered treatment for stable intertrochanteric fractures but that the dislocation (10/44) and infection rates (8/44) are very high in dementia.