When to Think and Do Bipolar in Inter Trochanteric Fractures.

Background: The life expectancy of the elderly population is increasing; hence, a rise in both intracapsular and extracapsular hip fractures. Early surgical intervention and ambulation are crucial to improving outcomes and reducing complications associated with recumbency. The optimal management of intertrochanteric femur fractures (IFFs) in elderly patients especially in cases of osteoporotic bone or high-risk fractures remains debated. Intramedullary fixation is most commonly used but may fail in patients with poor bone quality, making bipolar hemiarthroplasty (BHA) a potential alternative. Objectives: This review aims to evaluate the role of BHA in the management of IFFs in elderly patients, identifying fracture patterns amenable to BHA. Methods: A comprehensive literature review on BHA for IFFs in elderly patients was performed, focusing on indications, surgical techniques, and outcomes. Results: BHA can be considered beneficial for elderly patients with osteoporotic IFFs at high risk for fixation failure, particularly in fractures with severe comminution, reverse oblique patterns, or associated intraarticular pathologies. There is no consensus on definitive indications for BHA, with surgeon preference and fracture morphology guiding treatment decisions. The surgical technique varies, with approaches including posterolateral, direct lateral, and direct anterior methods. Cemented and uncemented femoral stems both have advantages and limitations, with cemented stems favoured for immediate weight-bearing in osteoporotic bone. Conclusion: BHA is a viable alternative to intramedullary fixation in elderly patients with high-risk IFFs. Further studies are needed to define clear indications and optimal techniques for BHA in this population.