Analysis of failure after treatment of senile femoral intertrochanteric fractures with InterTan nails

Abstract

Objective To analyze the causes for failed treatment of senile patients with femoral intertrochanteric fracture by the InterTan nailing system.Methods We retrospectively analyzed the clinical data of 337 elderly patients who had been treated in our department from April 2009 to December 2012 for femoral intertrochanteric fracture with closed reduction and internal fixation with InterTan nails.They were 189 males and 148 females,60 to 87 years of age (mean,69.7 years).According to the AO/OTA classification,71 fractures were type A1.1,89 type A1.2,78 type A1.3,51 type A2.1,35 type A2.2,7 type A2.3,and 6 type A3.We observed intraoperative and postoperative complications to analyze the causes for failed internal fixation and their preventive countermeasures.Results Of all the patients,205 were followed up for an average of 2.3 years (from 0.5 to 4.0 years).The rate of follow-up was 60.8％ (205/337).The fracture healed in 169 out of 205 patients after 2.6 to 3.4 months (average,2.9 months).Twelve months after operation,14 patients died and fixation failure occurred in another 22 patients (10.7％).Varus deformity was found 3 months postoperatively in 6 cases,of which 4 were complicated with cutout of a lag screw.At 6 months postoperatively,shortening of the femoral neck was found in 2 cases and varus deformity in 11 cases.After the intertrochanteric fracture healed during follow-up,3 cases of femoral fractures occurred at the end of the nail.We performed revision surgery for all these 22 cases of failed fixation.Arthroplasty was done for 5 cases and fixation was changed for 17 cases.After the revision surgery,fracture healed in 12 cases and 5 cases died within 12 months postoperatively.Conclusions The senile femoral intertrochanteric fractures can be successfully treated by the InterTan nailing system,but intraoperative and postoperative complications are inevitable.Good intraoperative manipulation is the key to preventing failure of the fixation and intensive postoperative follow-up is needed to watch out for complications like varus deformity,shortening of the femoral neck and cutout of a lag screw. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Old