Purpose: We evaluated changes in bone mineral density and biochemical bone turn over markers resulting from intravenous administration of zoledronic acid for the purpose of increasing bone mineral density and decreasing bone turnover rate in patients who had received operative treatment after hip fracture.
Materials and Methods: We carried out a retrospective study of 34 patients who had received injections of zoledronic acid after surgical treatment for hip fracture from January 2009 to June 2010, with a follow up period of more than one year. We evaluated pre and post T-scores of DXA in spine, proximal femur and femoral neck along with biochemical bone metabolic markers, and we then analyzed each factor.
Results: T score was enhanced in all cases with pre T-score -4.2 and post T-score -3.3 revealing statistical significance (P<0.05). In addition, two biochemical bone turnover markers were observed to decrease in most patients. Three days after drug administration, 7 patients(20.6%) had minor adverse effects. There were no serious complications such as atrial fibrillation.
Conclusion: No major adverse effects were observed, only minor ones in patients who had been injected with zoledronic acid for the prevention of osteoporotic fracture after surgical treatment for hip fracture. We confirmed the affirmative effects on changes in bone mineral density and biochemical bone turn over markers associated with the use of this drug.

Purpose: The purpose of this study was to evaluate the clinical features and risk factors of sequential bilateral hip fractures in elderly osteoporotic patients.
Materials and Methods: A total of 661 patients who had undergone surgical treatment for osteoporotic hip fractures from April 2001 to June 2011 were retrospectively reviewed. Thirty six patients who had experienced sequential bilateral hip fracture were classified as the BHF group and the rest of the patients were classified as the non-BHF group. Various clinical features, such as T-score of the proximal femur, dwelling pattern, any symptom of dizziness or dementia, health status by ASA classification, BMI, and history of osteoporosis treatment were reviewed and the risk factors of sequential bilateral hip fractures were evaluated.
Results: Mean age of subjects in the BHF group and the non-BHF group was 78.4 years(68-90 years) and 78.0 years(58-99 years), respectively. Mean time interval from initial fracture to second fracture in the BHF group was 29.9 months(2-102 months). No significant differences in T-score of proximal femur (P=0.276), dwelling pattern (P=0.623), dizziness or dementia (P=0.180), health status (P=0.399), and BMI (P=0.629) were observed between the two groups. Eight patients(22.0%) in the BHF group and 254 patients(40.6%) in the non-BHF group were treated with bisphosphonate medications due to osteoporosis during a period of at least one year or more (P=0.028).
Conclusion: Sequential hip fractures in elderly osteoporotic patients over the age of 70 were the result of low energy trauma, and most second fractures occurred within three years from initial injury. A multidisciplinary approach to prevention of a slip and treatment for osteoporosis are considered important to prevention of second hip fractures.

Purpose: We aimed to evaluate the outcome of fixation with cannulated screws for valgus impacted femoral neck fractures in patients over 70 years of age.
Materials and Methods: We reviewed the outcome in 33 patients older than 70 years with valgus impacted femoral neck fractures who were treated with cannulated screws fixation from May 2007 to December 2010. These patients were followed for at least a year. We assessed the fixation failure rate, body mass index (BMI), bone mineral density (BMD) of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation.
Results: We identified six patients (18.2%) with failure. Two patients with subtrochanteric fractures through the screw insertion site and another patient with osteonecrosis were excluded from the fixation failure group. No difference was found in age, BMI, BMD of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation between failure and non-failure groups.
Conclusion: The failure rate of cannualted screw fixation for valgus impacted femoral neck fractures in the elderly patients was not low. Risk of failure should be considered in the management of these patients and accurate assessment for fracture type should be performed using computed tomogram and clinical evaluation.

Purpose: Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture.
Materials and Methods: We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem.
Results: Sixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive.
Conclusion: Cerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.

The incidence of hip fractures is rapidly increasing with an aging population and is now one of the most important health concerns worldwide due to a high mortality rate. The effect of delayed surgery on postoperative outcomes has been widely discussed. Although various treatment guidelines for hip fractures in the elderly exist, most institutions recommend that operations are conducted as soon as possible to help achieve the most favorable outcomes. While opinions differ on the relationship between delayed surgery and postoperative mortality, a strong association between earlier surgery and improvement in postoperative outcomes (e.g., length of hospital stay, bedsore occurrence, return to an independent lifestyle), has been reported. Taken together, performing operations for hip fractures in the elderly within 48 hours of admission appears to be best practice. Importantly, however, existing evidence is based primarily on observational studies which are susceptible to inherent bias. Here, we share the results of a literature search to summarize data that helps inform the most appropriate surgical timing for hip fractures in the elderly and the effects of delayed surgery on postoperative outcome. In addition, we expect to be able to provide a more accurate basis for these correlations through a large-scale randomized controlled trial in the future and to present data supporting recommendations for appropriate surgical timing.

Purpose: This study was conducted in order to examine the usefulness of osteoconductive bone substitutes with zeta potential control (geneX^® ds; Biocomposites, England) by comparing the complications and radiographic evaluation with or without geneX^® ds augmentation for internal fixation with proximal femur nail antirotation (PFNA) for treatment of osteoporotic unstable intertrochanteric fractures.
Materials and Methods: A retrospective study of 101 patients who underwent fixation with PFNA in osteoporotic unstable intertrochanteric fractures was conducted from December 2015 to August 2020. The radiographic evaluation and complication rates were compared between patients with geneX^® ds (Group A: 41 cases) and those without geneX^® ds (Group B: 60 cases).
Results: In radiological valuation, the degree of blade sliding from the time immediately after surgery to one year after surgery was 1.4±1.2 mm and 5.8±2.7 mm in Group A and Group B, respectively (P<0.001). During the same time frame, a significant difference of 2.3±2.2° and 7.4±3.1°, respectively (P<0.001), in varus collapse, was observed for Group A and Group B.
Conclusion: Among patients fixed with PFNA for treatment of unstable intertrochanteric fractures, less blade sliding and varus collapse was observed for those with geneX^® ds augmentation compared to those without it. In addition, there was no increase in the incidence of complications. The authors believe it can be regarded as a safe and effective additive for intramedullary fixation for treatment of unstable intertrochanteric fractures.

Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients.
Materials and Methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs.
Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3.03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation.
Conclusion: Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

Purpose: Our study was done to evaluate the influence of postoperative delirium on the prognosis of hip arthroplasty, and risk factors for postoperative delirium in individuals older than 65.
Materials and Methods: Among patients who received hip arthroplasty in our hospital (WCH) between March 2004 and March 2008, we chose 193 patients for our study after excluding patients who had preoperative delirium and who had a history of dementia and cognitive dysfunction. We divided our cohort of 193 patients into two groups, 131 patients with postoperative delirium and 62 patients without delirium. We checked for clinical results for hip arthroplasty. We checked for multiple factors related to delirium.
Results: The mean hospital stay was 42.4±14.0 in the delirium group and 20.4±4.3 in the control group; the difference was significant. The mean preoperative cumulative ambulation score was 1.9±1.2 in the delirium group and 3.1±1.7 in the control group; the difference was significant. In 2 individuals of the control group and 4 of the delirium group, dislocation developed;and there was significant difference. There was a high prevalence of delirium among patients with hip fractures, and of histories of psychiatric diseases, alcohol abuse, liver cirrhosis and cerebral vascular disease. The delirium group had a significantly longer stay in the intensive care unit. On admission, the delirium group had significantly lower sodium and albumin compared to controls.
Conclusion: Because postoperative delirium after hip arthroplasty makes the prognosis worse, preoperative evaluation and management of risk factors is necessary.

Purpose: We wanted to evaluate the factors that influence the one-year mortality rate after bipolar hemiarthroplasty in elderly patients over 90 years of age and who had hip fractures.
Materials and Methods: In this retrospective study, we enrolled 42 cases (29 females and 12 males) that were treated by bipolar hemiarthroplasty for hip fractures between April 1999 and April 2008. The mean age was 94 (range: 90~101) years. We compared such variables as age, gender, BMD (bone mineral density), the ASA (American Society of Anesthesiologists) score, the type of fracture, the operation time, the type of anesthesia, the length of the ICU (intensive care unit) care, the length of hospitalization, operative delay and the postoperative ambulatory capability between the one-year mortality group and the control group (alive over a minimum of 1-year), and we investigated the risk factors related to one-year mortality.
Results: The one-year mortality rate was 32%. There were significant relationships between the postoperative one-year mortality and the ASA score, the length of the ICU care, operative delay and the postoperative ambulatory capability. The one-year mortality rate in the trochanteric fracture group was significantly higher than that in the neck fracture group. However, there were no relationships between the one-year mortality and age, gender, BMD, the length of operation, the type of anesthesia and the length of the hospitalization.
Conclusion: The preoperative ASA score was significantly higher in the one-year mortality group among the elderly patients over 90 years of age and who were treated with bipolar hemiarthroplasty for hip fractures. The length of the ICU care, operative delay and the postoperative ambulatory capability were significantly associated with one-year mortality, and so all of these should be considered as postoperative prognostic factors.

Purpose: The purpose of this study was to evaluate the effects of alendronate on bone mineral density (BMD) and to determine the persistency and side effects of alendronate treatment after hip fractures.
Materials and Methods: 452 patients who underwent surgery for hip fractures from March 2000 to February 2007 were retrospectively included. The hip fractures consisted of 218 cases of femur neck fractures and 234 cases of intertrochanteric fractures. There were 254 women and 198 men with a mean age of 73.4 years (range: 60~95 years) at the time of surgery. The BMD was assessed in 398 patients and 348 were diagnosed with osteoporosis, while 102 received alendronate for treatment. The persistency with alendronate treatment and change of the BMD were evaluated annually. We also evaluated the side effects and reasons for discontinuation.
Results: The prescription rate of alendronate was 29.3% and the persistency rate over 1 year was 33%. The annual BMD of the lumbar spine showed a 9.11% increase the first year, a 4.5% increase the second year and a 3.5% increase the third year, while negative changes were noted in the proximal femur as a 1.89% decrease the first year, a 1.38% decrease the second year and a 0.97% decrease the third year. The BMD changes were 11%(L: Lumbar spine) and 1.1%(F: Femur) for the T-scores <-4.0, 6.3%(L) and 0.9%(F) for the T-scores -3.0~-4.0, and 3.8%(L) and -3.5%(F) for the T-scores >-3.0, respectively. The BMD changes in the patients with femur neck fractures and who were treated with hemiarthroplasty were 15.6%(L) and -3.9%(F). The BMD changes in the patients with intertrochanteric hip fractures and who were treated with compression hip screws or hemiarthroplasty were 18.7%(L), 0.77%(F), 24.2%(L) and 1.19%(F), respectively. Gastrointestinal problems(19.1%) were the most common cause for discontinuation of alendronate.
Conclusion: It is important for doctors to approach osteoporosis more carefully and educate patients to follow the prescriptions in order to improve the low prescription and persistency rates for the management of osteoporotic hip fractures. Administration of alendronate may have a positive influence on the BMD of the proximal femur by lowering the rate of decreased BMD more than would be expected.