Causes for failed internal fixation of femoral intertrochanteric fracture in senile patients

Abstract

Objective To investigate the causes and countermeasures of failed internal fixation of femoral intertrochanteric fracture in the senile patients. Methods From September 2008 to June 2014, 96 patients with femoral intertrochanteric fracture were operated on using varied internal fixations. These patients were 42 males and 54 females in age range of 65-98 years (mean, 72.5 years). There were 19 Evans type Ⅰ, 32 type Ⅱ, 25 type Ⅲ, 16 type Ⅳ and 4 type Ⅴ fractures. Internal fixation methods, failure causes as well as types, and failure incidence were analyzed. Results All the patients were followed up for 3 to 36 months (mean, 11.8 months). Totally 9 patients resulted in failed internal fixation, with the failure rate of 9% (2 stable and 7 unstable fractures). Failed internal fixations were proximal femoral nail antirotation (PFNA, n=2), anatomic plate fixation (n=3), locking plate osteosynthesis (n=8) and dynamic hip screw (n=1). Failure types were hip varus and shortening deformity because of incorrect operation and internal fixation breakage or loosening as the screws were not tightened during operation. Conclusion Osteoporosis, incorrect internal fixation methods, faulty operative procedures and postoperative rehabilitation are the most important factors responsible for the internal fixation failure for femoral intertrochanteric fracture in senile patients. Key words: Femoral fractures; Fracture fixation, internal; Internal fixation failure