Management of the cut-out of various forms of osteosynthesis for proximal femoral fractures

Abstract

Proximal femoral fractures are acommon type of injury in older people. Acut-out of the femoral neck screw after initial osteosynthetic surgery of proximal femoral fractures is afrequent and feared complication. There could be different causes for cut-outs. Osteoporosis and necrosis of the femoral head could be biological reasons for cut-outs; however, mechanical factors, such as reduction, implant position and morphological characteristics of fractures also have amajor influence on the cut-out rate. The treatment of the cut-out is often complex and depends on the destruction of the femoral head and the acetabulum. If the bone quality is still good and the head is not completely destroyed, areosteosynthesis can be performed. Conversion to an endoprosthetic replacement is often the only possibility. Endoprosthetic treatment is often complex and associated with ahigh morbidity.