The Efficacy of a Double Wiring Technique in Cementless Hemiarthroplasty for Unstable Basicervical Intertrochanteric Fractures: A Propensity Score-Matched Analysis of Femoral Neck Fractures

BACKGROUND: Basicervical intertrochanteric (IT) fractures are a distinct subtype of proximal femoral fractures, characterized by marked rotational instability and a high risk of fixation failure. In elderly patients, primary arthroplasty may serve as a viable option. This study aimed to report the clinical outcomes of cementless hemiarthroplasty using a double wiring technique for unstable basicervical IT fractures in elderly patients and to compare them with those after cementless hemiarthroplasty for displaced femoral neck (FN) fractures. METHODS: We retrospectively reviewed 45 patients aged 75 years and older who received cementless bipolar hemiarthroplasty using a double wiring technique for unstable basicervical IT fractures and were followed up for more than 1 year between January 2015 and December 2022. After propensity score matching (2 : 1), the control group comprised 90 patients who underwent cementless hemiarthroplasty for displaced FN fractures. All operations were performed via a short external rotator-preserving posterolateral approach. The perioperative results, postoperative complications, and 1-year mortality of the 2 groups were investigated and compared. RESULTS: The IT group exhibited significantly longer operation times (p = 0.031) and greater total blood transfusion volume (p = 0.027) than the FN group despite no significant differences in blood loss and transfusion rate. No significant differences were observed in postoperative medical and surgical complications. Wire breakage occurred in 7 patients, and of those, 5 showed proximal migration of the greater trochanter fragment. However, there was no subsequent functional impairment in these patients. At 1 year after the index surgery, there were no significant differences in walking ability and mortality rate between the 2 groups. CONCLUSIONS: Cementless hemiarthroplasty with a double wiring technique for unstable basicervical IT fractures demonstrated clinical outcomes and 1-year mortality equivalent to those of hemiarthroplasty for displaced FN fractures, suggesting it as a feasible and safe option in osteoporotic elderly patients with these fractures.