Considerations With Failed Intertrochanteric and Subtrochanteric Femur Fractures

Dziadosz, Daniel

doi:10.1097/bot.0000000000000289

Cited by 18 publications

(32 citation statements)

References 15 publications

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“…Elderly patients with metal failure of subtrochanteric fractures usually have poor bone quality in the proximal femur. In this case, re xation will prolong their bed-rest period and prevent the patient from early ambulation, often necessitating replacement surgery [8]. THA enables patients to achieve early mobilization and early weight-bearing.…”

Section: Discussionmentioning

confidence: 99%

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Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

Jin

Kim

et al. 2020

Preprint

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Background Failed treatment of subtrochanteric fractures commonly leads to pain, limping, and poor function. Cementless total hip arthroplasty (THA) could be an option as a salvage procedure in such cases. This study was to evaluate the clinical and radiological results and complications of this treatment in our hospital. Method Eighteen cementless THAs for failed treatment of subtrochanteric fractures were performed at our institution between January 2001 to December 2017. There were eleven males and seven females, and the average age was 74 years (range 57.0-89.0). Eight patients were previously operated with an intramedullary nail, six patients were treated with a dynamic hip screw, two patients were treated with an angled blade plate, one patient was treated with a proximal femur locking plate, and one patient was treated with a dynamic compression plate. Results The mean follow-up was 5.2 years (range 2.2-10.8). The mean duration of the operation was 98.0 minutes (standard deviation [SD],15.4; range 70-135). The mean total blood loss was 992.2 mL (SD,171.2; range 640-1260 mL), and the amount of transfusion was 2.2 units (SD, 0.8, range 1-4). The mean Harris hip score (HHS) was 38.2 (SD, 9.3; range, 24-56) preoperatively and 85.4 (SD, 4.9; range, 79-92) at the last follow-up. Compared to the patients treated with plate-screws, those treated with an intramedullary nail had significantly shorter surgical duration, fewer blood transfusions, and less intraoperative blood loss. Kaplan-Meier survivorship with an endpoint of revision was 94.4% (95% confidence interval 72.7-99.9) at five years. Conclusion Cementless THA is one of the acceptable procedures for failed treatment of the subtrochanteric fracture with fewer complications.

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Section: Discussionmentioning

confidence: 99%

“…xation should be made a priority, whereas for elderly patients with poor bone quality, hip replacement is a promising option [8]. Total hip arthroplasty (THA) is accepted as a successful salvage procedure for failed xation of the subtrochanteric fractures [9].…”

Section: Introductionmentioning

confidence: 99%

Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

Jin

Kim

et al. 2020

Preprint

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“…Unlike hip arthroplasty, which is characterized by limited longevity, revision internal fixation preserves the femoral head; thus, further revision surgery due to prosthesis abrasion is unnecessary. In this regard, orthopedic surgeons should spare no effort to preserve native bone and achieve fracture union with this procedure, especially in active patients younger than 50 years of age [2,21].…”

Section: Femoral Head Salvage Proceduresmentioning

confidence: 99%

“…If the decision is made to proceed with revision internal fixation, it is important to obtain stable fixation of the fracture fragments and avoid varus malreduction [19]. Eliminating the fracture gap by means of a compression technique and sufficient bone grafting and taking care to preserve the vascularity of fracture sites could jointly improve the environment for fracture healing [2,42].…”

Section: Technical Challenges and Considerationsmentioning

confidence: 99%

“…Intertrochanteric (IT) fractures are common, accounting for almost half of all hip fractures and resulting in a great burden on orthopedic services [1][2][3]. Although most IT fractures can be treated successfully with contemporary surgical techniques and internal fixations such as intramedullary nails and sliding hip screws, clinical failures still occasionally occur, with reported data indicating a range from 0.5 to 56% depending on the fracture type, patient status, and quality of the reduction and fixation [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art

Liu

Jin

Zhang

et al. 2020

BMC Musculoskelet Disord

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Failed treatment of intertrochanteric (IT) femoral fractures leads to remarkable disability and pain, and revision surgery is frequently accompanied by higher complication and reoperation rates than primary internal fixation or primary hip arthroplasty. There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. Salvage options are determined according to patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency. In physiologically young patients, care should be taken to preserve the vitality of the femoral head with salvage internal fixation; however, for the elderly population, conversion arthroplasty can result in early weight bearing and ambulation and eliminates the risks of delayed fracture healing. Technical challenges include a difficult surgical exposure, removal of broken implants, deformity correction, critical bone defects, poor bone quality, high perioperative fracture risk, and prolonged immobilization. Overall, the salvage of failed internal fixations of IT fractures with properly selected implants and profound techniques can lead to the formulation of valuable surgical strategies and provide patients with satisfactory clinical outcomes.

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Results of revision intramedullary nailing with and without auxillary plate in aseptic trochanteric and subtrochanteric nonunion

Dietze

Brand

Friederichs

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Aim of this study was to investigate whether limited open auxiliary angle stable plate fixation has an effect on functional and radiologic outcomes one year after revision intramedullary nailing in aseptic trochanteric and subtrochanteric fracture nonunion. Methods In a retrospective analysis, surgically revised aseptic trochanteric and subtrochanteric nonunion was evaluated in a total of 190 consecutive patients ranging from 18 to 94 years between 12/2005 and 10/2018. Results One year after revision intramedullary nailing, nonunion healing was assessed in 129 out of 136 patients (95%) in group 1 without auxiliary plate fixation and in 51 out of 54 patients (94%) in group 2 with auxiliary plating (p = 0.23). In group 1, range of motion (ROM) was unrestricted in 88 patients and still restricted in 48 patients. In group 2, ROM was free in 34 patients and restricted in 20 patients (p = 0.25). The mean Lower Extremity Functional Scale (LEFS) was 56 points in group 1 and 55 points in group 2 (p = 0.55). Conclusion This study did not demonstrate significant differences in functional and radiologic outcomes following revision intramedullary nailing of aseptic trochanteric and subtrochanteric fracture nonunion. Limited open auxiliary plate fixation might be a reasonable option especially in cases of relevant varus axis deviation and comminuted or atypical fracture configurations, regardless of patients’ age. Retrospectively registered with the German Clinical Trials Register (01/25/2021; ID: DRKS00024112).

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Considerations With Failed Intertrochanteric and Subtrochanteric Femur Fractures

Cited by 18 publications

References 15 publications

Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art

Results of revision intramedullary nailing with and without auxillary plate in aseptic trochanteric and subtrochanteric nonunion

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