Internal Fixation Of Intertrochanteric Fracture Research Articles

The effect on outcomes of the application of circumferential cerclage cable following intramedullary nailing in reverse intertrochanteric femoral fractures.

The aim of this study was to evaluate the effect on union results of the application of cerclage cable around the lateral femoral wall (LFW) in postoperative fracture displacement. A retrospective evaluation was made of all the cases of reverse intertrochanteric fractures over a 7-year period in a trauma center. The study included 69 fractures treated with intramedullary nailing. The age of the patients, postoperative reduction quality and complications such as mechanical failure and non-union (1.4%) were obtained from the medical records. Changes in the neck-shaft angle, the amount of LFW displacement and telescoping of proximal femoral nail antirotation blades and lag screws were measured on anteroposterior and lateral radiographs. The functional evaluation of the Harris Hip Score was recorded at the final follow-up examination. The mean age of the patients was 56.31years (range 18-93years). Closed reduction was applied in 37 (53.7%) cases, open reduction in 10 (14.5%) and with cerclage cable in 22 (31.8%). Mechanical failure developed in 8 (11.5%) cases where cerclage cable was not used. In 2 of these 8 cases, open reduction was successful. In the patients where cerclage cable was applied, no mechanical failure developed and no case underwent revision surgery. In the cases where cerclage cable was not used, a significantly higher rate of telescoping was found. (p = 0.001). The application of cerclage cable was seen to significantly reduce the amount of LFW displacement (2.23mm vs 8.86mm) and shorten the time to partial weight bearing (p = 0.000). In reverse intertrochanteric fractures, the application of circumferential cerclage cable with cephalomedullary nailing contributes to primary stability and accelerates mobilization. Therefore, it can be considered a good option. It reduces the risk of failure internal fixation for intertrochanteric fracture.

Hemiarthroplasty with Wagner SL prosthesis for failed internal fixation of intertrochanteric fractures in elderly patients

Objective To investigate the clinical outcomes of hemiarthroplasty with Wagner SL prosthesis in treating failed internal fixation of intertrochanteric fractures of elderly patients. Methods A retrospective case series study was conducted on the clinical data of 14 patients with failed internal fixation of intertrochanteric fractures admitted between March 2015 to April 2018. There were seven males and seven females with a mean age of 82.2 years (range, 75-94 years). The primary internal fixators were proximal femoral nail anti rotation in nine patients, dynamic hip screw in three patients, and proximal femoral locking plate in two patients. The main causes of internal fixation failure were screw loosening in six patients, cutting out of screws in five patients, nonunion in two patients, and plate breakage with nonunion in one patient. Affected limb shortening and coxa varus deformity to various degrees were seen in all the patients before operation. The mean interval from internal fixation to hemiarthroplasty was 6.6 months (range, 2-12 months). All patients received hemiarthroplasty using Wagner SL prosthesis, of which nine patients had additional trochanter claw plate with titanium cable fixation and two patients had tension band wire fixation. The operation time, intraoperative, and postoperative complications were recorded. Harris hip scores were measured before operation and at the last follow up to evaluate hip function. Radiographs were performed to assess the fracture healing, prosthesis position, and biological fixation. Results All patients were followed up for 6-30 months (mean, 14.5 months). The mean operation time was (108.0±12.4)minutes (range, 88-130 minutes). No iatrogenic fracture occurred during the operation. One patient was seen contralateral intertrochanteric fracture during follow-up, and no complications such as periprosthetic fracture, prosthetic sinking, and infection occurred in the 13 patients. The Harris score increased from (26.1±7.5)points before operation to (83.1±4.1)points after operation (P<0.01). All patients were able to stand and walk, of which four needed crutch assistance. At the last follow-up, X-ray film showed that the prosthesis was well positioned and that all of them reached bony fixation. Fourteen cases of greater trochanteric fracture were healed, with two cases of slight displacement. Conclusions Hemiarthroplasty is an effective remedial treatment for failed internal fixation of intertrochanteric fractures in the elderly, which can improve hip function and enhance the life quality of patients. Wagner SL prosthesis can obtain stable fixation. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure

Pseudoaneurysm in medial thigh after the internal fixation for intertrochanteric fracture; a case report

Pseudoaneurysm in medial thigh after the internal fixation for intertrochanteric fracture; a case report

Tip-Apex Distance Is Most Important of Six Predictors of Screw Cutout After Internal Fixation of Intertrochanteric Fractures in Women.

Background:Six risk factors for screw cutout after internal fixation of intertrochanteric fractures have been reported. The purpose of the present study was to evaluate and compare the impact of the 6 risk factors of screw cutout to clarify the most important one.Methods:We enrolled 8 consecutive patients who had screw cutout and 48 random control subjects after internal fixation of intertrochanteric fractures treated with proximal femoral nail antirotation systems at our institution. All of the patients were female. The group that had screw cutout and the control group were retrospectively evaluated and compared with respect to the OTA/AO classification, presence of a posterolateral fragment, types of reduction pattern on anteroposterior and lateral radiographic images, position of the screw, and the presence of a tip-apex distance (TAD) of ≥20 mm. The impact of each factor on screw cutout was assessed using backward stepwise multivariable logistic regression analysis with the Akaike information criterion. Risk stratification was assessed using classification and regression tree (CART) analysis.Results:Among 6 risk factors, only a TAD of ≥20 mm had a significant impact on screw cutout, with an adjusted odds ratio of 12.4 (95% confidence interval, 1.6 to 129.0; p = 0.019). CART analysis also demonstrated that a TAD of ≥20 mm was the most important risk stratification factor (p < 0.001).Conclusions:Among the 6 previously reported screw cutout-related factors, only a TAD of ≥20 mm was associated with screw cutout after internal fixation of intertrochanteric fractures with proximal femoral nail antirotation systems.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Risk factors related to failure of internal fixation for intertrochanteric fracture in Chinese patients: a meta analysis and review

Objective To evaluate the risk factors related to the failure of internal fixation for intertrochanteric fracture in Chinese patients. Methods A comprehensive Meta analysis of the clinical research from January 2005 to August 2016 on the failure of internal fixation for intertrochanteric fracture in Chinese patients was conducted after Pubmed, CNKI, Wanfang Data, et al., had been searched. Revman5.0 was used to perform the heterogeneity test and calculate the OR value and 95%CI after quality assessment and retrieval of the qualified data. Results Included for this analysis were 23 studies involving 4,031 pa-tients of whom 588 failed. The factors related to the failure of internal fixation for intertrochanteric fracture included patient age [OR=0.51, 95%CI (0.30, 0.90), P 0.05], injury cause [OR=1.68, 95%CI (0.66, 4.25), P >0.05] or type of internal fixation [OR=0.37, 95%CI (0.06, 2.14), P >0.05]. Conclusions High age, concomitant osteoporosis, complicated fracture pattern, unsatisfactory fracture reduc-tion, TAD≥25 mm, time for full weight bearing < 6 weeks, and concomitant internal diseases may be the risk factors closely related to the failure of internal fixation for intertrochanteric fracture in Chinese patients. There has been no sufficient evidence to show that gender, injury cause or type of internal fixation may be associated with the failed internal fixation for intertrochanteric fracture. Key words: Hip fractures; Fracture fixation, internal; Treatment failure; Meta-analysis

Modular S-ROM prosthesis for failed internal fixation of intertrochanteric fracture

Objective To observe the outcomes of hip arthroplasty with modular S-ROM prosthesis for failed internal fixation of intertrochanteric fracture. Methods Fifteen patients who had been admitted for failed internal fixation of intertrochanteric fracture from January 2013 to May 2015 were reviewed retrospectively in this study. They were 9 men and 6 women, aged from 55 to 86 years (average, 72 years). Their primary internal fixation methods included dynamic hip screw (DHS) in 7 patients, proximal femoral nail anti-rotation (PFNA) in 5 and proximal femoral locking plate in 3. The causes for internal fixation failure were implant loosening in 5 patients, screw breakage in 6, and cutting-out of screws in 4. All the patients received hip arthroplasty with modular S-ROM prosthesis to treat their fracture nonunion or displacement. Harris hip scores were measured before operation and at the final follow-up. Results Their average operative time was 156 min (from 118 to 180 min) and average intraoperative blood loss 432 mL (from 230 to 700 mL). No fracture or neurovascular damage occurred during operation. The 15 patients were followed up for 13 to 35 months (mean, 24 months). Postoperative dislocation of the artificial joint happened in one patient and nonunion of the greater trochanter due to massive bone defects was observed in 2 patients. Follow-ups showed none of the patients had such severe complications as infection, deep vein thrombosis or peri-prosthesis fracture. At the last follow-up, 15 patients obtained Harris hip score of 90.6 (from 78 to 95), with 11 excellent, 3 good and one fair cases. Conclusion Hip arthroplasty with modular S-ROM prosthesis is a safe and effective treatment for failed internal fixation of intertrochanteric fracture. Key words: Arthroplasty, replacement, hip; Hip fractures; Fracture fixation, internal; Treatment failure

A clinical study on arthroplasty for failed internal fixation of hip fractures and review of literature.

Background & Objective:Hip fracture is common osteoporotic fracture associated sometimes with failed internal fixation. Joint replacement is commonly used to salvage failed internal fixation of hip fractures (FIFHF). Our objective was to present the outcome of Arthroplasty after FIFHF in our patients.Methods:A prospective analysis was made on consecutive patients who underwent prosthetic replacements for FIFHF in Orthopaedics Department of Xuanwu Hospital between June 2012 and January 2015. Fifty six patients were included. There were 32 cases of failed internal fixation of femoral neck fracture (FIFFNF) and 24 cases of failed internal fixation of intertrochanteric fracture (FIFIF). The reoperations included 36 cases of total hip replacements, and 20 cases of bipolar femoral head replacements. Cemented prostheses were used in 19 patients (long-stems in 7 patients), and uncemented prostheses in 37 patients (long-stems in 12 patients). The patients were followed up for a minimum of 12 months or until their death.Results:Two patients died of pulmonary infection in the perioperative period, two died of myocardial infarction in two months after the operation, and the rest survived 12 month follow-up at the least. The mean Harris hip scores of the patients were 47 and 85 before and after the operation, respectively. The rate of Excellent and Good results is 82.7%. T tests showed that difference between pre and post-operation Harris hip scores is statistically significant (p <0.001).Conclusions:Arthroplasty may serve as a suitable salvage technique for FIFHF, and long-stem prosthesis replacement is proved to obtain reliable curative effect, especially in FIFIF.

Conversion Hip Arthroplasty in Failed Fixation of Intertrochanteric Fracture: A Propensity Score Matching Study

BackgroundConversion hip arthroplasty is a salvage procedure for failed internal fixation of intertrochanteric fractures. However, the technical difficulties and perioperative morbidity of conversion arthroplasty are uncertain. MethodsWe compared the type of arthroplasty (total hip arthroplasty or hemiarthroplasty), operative parameters, perioperative morbidity, 1-year mortality, implant stability, and clinical results of 33 conversion hip arthroplasties due to a failed internal fixation of intertrochanteric fracture with those of a matched control group of 33 primary hip arthroplasties due to the same fracture. Propensity score was used for the control matching of gender, age, and body mass index. ResultsTotal hip arthroplasty was more frequently performed in the conversion group (10/33) compared to the primary group (3/33) (P = .016). The operation time, perioperative blood loss, amount of transfusion, and risk of femoral fracture during the operation were increased in the conversion group. The overall 1-year mortality was 3% (1 patient) in the conversion group and 9% (3 patients) in the primary group (P = .307). At a mean of 3-year follow-up, there was no significant difference in clinical results and none of the implants were loose in both groups. ConclusionIn patients with failed internal fixation of intertrochanteric fracture, conversion hip arthroplasty should be planned and executed, bearing in mind the increased operative morbidities corresponding to operation time, perioperative blood loss, requirement of transfusion, and intraoperative femoral fracture.

Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries.

BackgroundAt present, the exact mechanism of postoperative delirium has not been elucidated. The purpose of this study was to analyze the incidence of delirium in patients undergoing orthopedic surgeries and to explore possible related factors.MethodsThis is a retrospective study. We used 582 patients who had undergone orthopedic surgery between January 2011 and December 2014. The surgeries consisted of 155 cases of internal fixation for intertrochanteric fracture (IFIF), 128 cases of femoral head replacement (FHR), 169 cases of total hip arthroplasty (THA) and 130 cases of total knee arthroplasty (TKA). Among the 582 patients, 75 developed postoperative delirium (an incidence of 12.9%). The demographics of the patients, which included age, gender, operation duration and blood loss, were statistically analyzed with univariate logistic regression analysis and then multivariate logistic regression. To investigate the influences of different electrolytes disorders for postoperative delirium, the Chi-square test was used.ResultsMultivariate logistic regression analysis indicated that postoperative delirium incidence in patients aged 70–79 years and in patients aged ≥80 years was higher than that in patients aged <70 years, odds ratio (OR) values were 6.33 and 26.37, respectively. In addition, the incidence of postoperative delirium in the group of patients with electrolyte disorders was higher than that in the normal group (OR, 2.38). There were statistically significant differences between the delirium group and the non-delirium group in the incidences of the sodium and calcium disorders.ConclusionsAging and postoperative electrolyte disorders (hyponatremia and hypocalcemia) are risk factors for postoperative delirium in patients undergoing orthopedic surgeries.

Logistic regression analysis of risk factors for femoral head osteonecrosis after healed intertrochanteric fractures.

To evaluate the potential risk factors of the development of femoral head osteonecrosis after healed intertrochanteric fractures. We retrospectively reviewed all patients who were operated upon with closed reduction and internal fixation for intertrochanteric fractures by our medical group from December 1993 to December 2012. Patients with healed fractures were identified. Age, gender, comorbidities favouring osteonecrosis, causes of injuries, fracture patterns, the location of the primary fracture line, time from injury to surgery, fixation methods, and the development of femur head osteonecrosis of these patients were summarised. Univariate and multivariate logistic regression analysis were performed to evaluate the correlation between potential risk factors and the development of femoral head osteonecrosis. A total of 916 patients with healed intertrochanteric fractures were identified. Femoral head osteonecrosis was found in 8 cases (0.87%). According to the results of univariate logistic regression, a more proximal fracture line, fixation with dynamic hip screws and age were found to be statistically significant factors. The results of multivariate logistic regression analysis indicated that the statistically significant predictors of femoral head osteonecrosis were younger age (odds ratio [OR] = 17.103; 95% confidence interval [CI], 1.988-147.111), a more proximal fracture line (OR = 31.439; 95% CI, 3.700-267.119) and applying dynamic hip screw as the internal fixation (OR = 11.114; 95% CI, 2.064-59.854). Regular follow-up is commended in young patients with a proximal fracture line who underwent closed reduction and internal fixation with dynamic hip screw, even though the bone had healed.

Total cost of hospitalization after internal fixation of intertrochanteric fracture

Objective To analyze the factors influencing the total cost of hospitalization after internal fixation of intertrochanteric fracture. Methods Enrolled in this study were 142 patients with intertrochanteric fracture who had been treated at our department between March 2013 and August 2014. They were 54 men and 88 women, aged from 24 to 95 years (average 69.8 years) . Intramedullary fixation was adopted in 135 cases while extramedullary fixation in 7. By AO classification, 32 cases were type A1, 75 type A2 and 35 type A3. We analyzed their demographic data, fracture-associated factors, bleeding-associated factors and surgery-associated factors. For univariate analysis, the independent sample t test was performed between 2 groups. One-Way ANOVA analysis was performed among several groups. For multivariate analysis, multivariate linear regression analysis was performed. P<0.05 was regarded as statistically significant. Results The independent sample test revealed that the total cost of hospitalization for those with preoperative deep venous thrombosis (6.9±1.0×105 ￥) was significantly higher than for those without (5.0±0.8×105 ￥) and the total cost for those undergoing intramedullary fixation (5.5±1.2×105 ￥) was significantly higher than for those undergoing extramedullary fixation (4.4±0.7×105 ￥) (P<0.05) . The multiple linear regression analyses showed that preoperative deep venous thrombosis (t=11.750, P<0.001) , perioperative transfusion (t=2.803, P=0.006) , hospital stay (t=5.949, P<0.001) and intraoperative blood loss (t=2.885, P=0.005) were the independent factors influencing the total cost of hospitalization. Conclusions Preoperative deep venous thrombosis, perioperative transfusion, intraoperative blood loss, and hospital stay may influence the total cost of hospitalization for patients undergoing internal fixation of intertrochanteric fracture. More attention should be paid to control of the total cost of hospitalization in addition to ensuring the perioperative life safety. Key words: Hip fractures; Fracture fixation, internal; Factor analysis, statistical; Cost of hospitalization

Uncemented hip arthroplasty for failed internal fixation of peritrochanteric fracture

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture. Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study. The patients aged 67.2 years(range, 41-80 years) composed 6 males and 11 females. There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture. The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients. Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation. Harris score was used for evaluation of the results of hip arthroplasty. Preoperative Harris score was (32.6±6.8)points. Results All the patients were followed up for 6 to 48 months. One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery. One patient had secondary subsidence of the femoral stem without pain and limitation of motion. One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation. Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening. Harris hip score significantly improved to (79.2±15.9)points at the final follow-up (P<0.01). Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture. The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability, and avoids the complications of bone cement use. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure

Internal fixation of intertrochanteric fractures using the percutaneous compression plate: the event of cutting out and its prediction by the tip-apex-distance

In a recent study, the analyzed percutaneous compression plate (PCCP) data identified the tip-apex-distance (TAD) as the most valuable risk factor for the reoperation rate and in particular for the event of cutting out of the cephalic screws after internal fixation of intertrochanteric fractures. However, it is unknown which potential distance between the tip of the screws and the apex of the femoral head is most valuable in predicting the event of cutting out. As the PCCP device has two cephalic screws, there are at least three different distances which can be measured, including the distance between the tip of the lower screw and the apex of the femoral head, the distance between the center of the line between the two cephalic screws and the apex, and finally between the tip of the upper screw and the apex. Our study was motivated by the question which measurement can provide the best results for the prediction of the event of cutting out of the cephalic screws. The digitalized postoperative X-ray films of 174 patients with 174 PCCP implants were analyzed, and we obtained three different measurements for every patient. The primary outcome was the proportion of those patients with a cutting out of the screws. A univariate logistic regression was performed to assess the impact of the TAD on the event of cutting out. To describe the degree of consistency among measurements, we calculated an intra-class correlation coefficient (ICC) and the corresponding 95 % confidence limits. For each of the different measurements, we performed a receiver operating characteristic (ROC) curve analysis and calculated the area under the curve (AUC) and the corresponding 95 % confidence limits. In order to identify the most valuable distance measure, we added pairwise comparisons of the AUCs. Out of 174 patients, six patients (3.4 %) were reoperated due to cutting out of the cephalic screws. In the univariate logistic regression model, the p value was 0.0012 (OR 0.874; 95 % CI 0.806 to 0.948). The ROC curve analysis showed similar results for the different measurements; however, the highest AUC value was obtained for the center position. In conclusion, all three measurements provide similar results and are suitable to predict the risk of cutting out of the cephalic screws.

Total Hip Arthroplasty Using Non-Modular Cementless Long-Stem Distal Fixation for Salvage of Failed Internal Fixation of Intertrochanteric Fracture

Thirty one patients were treated with salvage total hip arthroplasty (THA) for failed internal fixation of intertrochanteric fracture. After a mean follow-up of 47.5 months, all patients reported remarkable pain relief and return to ambulation. Twenty five patients had no pain, and 6 patients complained of residual trochanteric low-grade pain without compromise of activities. The Harris Hip score increased from a preoperative average of 28.4 points to a postoperative average of 85.6 points. All patients demonstrated successful bony union and five had Brooker I or II heterotopic ossification. Seven patients had intraoperative or early complications and were treated successfully. There was no infection, re-fracture, loosening, or revision for any reason. Salvage THA using non-modular cementless long-stem prosthesis represents an effective procedure after failed intertrochanteric fixation.

Treatment of stable and unstable intertrochanteric fractures with selfdynamisable internal fixator (concept of double dynamisation).

BACGROUND/AIM. Intertrochanteric fractures of the femur are the third most common fractures among all bone fractures. Today in everyday orthopedic practice a number of different methods of treatment of trochanteric fractures of the femur are applied. Despite the improvement in the development of new implants, the percentage of serious complications of the treatment of these fractures remains very high, varying from 10% to 20%. One of the most serious complications of internal fixation of intertrochanteric fractures is nonunion of fractures due to the lack of additional axial dynamisation of implants. The aim of this study was to determine the efficacy of double dynamisation in stable and unstable intertrochanteric fractures treatment using the self dynamisable internal fixator. During the period from 2000 to 2009 we analyzed the use of selfdynamisable internal fixator (SIF implant) in the treatment of 247 patients with stable and unstable intertrochanteric fractures. Fracture types were classified according to the AO Fracture Classification/Orthopaedic Trauma Association Scheme. Salvati and Wilson scoring systems were used for functional assessment considering pain, walking ability and hip movements of operated patients. Of the total number of treated patients, 134 were males and 113 females, aged 19 to 90 (average 49.6) years. More than a half of the patients were older than 50 years. Monitoring of the patients after the operation was carried out clinically and radiographically for a period of three to six months in all the patients, whereas a 2-year follow-up was conducted in 176 (71.2%) patients. The average duration of surgery was 47 min, the average blood loss 145 mL, and the average fluoroscopy time was 16 sec (8-97 sec). The average time for union was 3.7 months (3-6.6 months). Double dynamisation (dynamisation along the neck and shaft of the femur) was observed in 85 (34.4%) patients, and was on average 4.3 mm (1.5-8 mm). All fractures managed with dynamisation implants healed completely within no later than six months after the surgery. In 17 cases there was a cut-out phenomenon of implant, while in seven cases there was mechanical implant failure. Complications were detected within 3 to 6 weeks after surgery, and treated by the method of intramedullary fixation. During the study, there were no cases of infection and thromboembolic complications detected. The concept of double dynamisation improves the fracture healing in the stable and unstable intertrochangeric fractures using the selfdynamisable internal fixator. This biological method of fixation provides healing of intertrochanteric fracture in the optimum period of time, significantly reducing the risk for mechanical failure.

Surgical Outcome for Hip Fractures in Patients with and without Parkinson's Disease

PURPOSE. To compare surgical outcome of hip fractures (in terms of the ability to walk and complications) in patients with and without Parkinson's disease (PD). METHODS. Records of 207 patients who underwent surgery for femoral neck fractures were reviewed. Of whom, 9 men and 26 women with PD aged 58 to 89 (mean, 76.8) years underwent hemiarthroplasty for subcapital fractures (n=22) or internal fixation for intertrochanteric fractures (n=13). The remaining 36 men and 136 women with no PD aged 61 to 96 (mean, 81.8) years underwent hemiarthroplasty (n=108) or internal fixation (n=64) for subcapital (n=120) or intertrochanteric (n=52) fractures. None of the patients had pathological fractures, and all had been ambulatory prior to the fracture. According to the Columbia classification system, severity of PD was grade II in 11, grade III in 11, and grade IV in 13 patients. RESULTS. Respectively for the patients with and without PD at the one-year follow-up, 68.2% and 79.6% of those treated with hemiarthroplasty and 46.2% and 62.5% of those treated with internal fixation were able to walk with or without assistive devices. 81.8%, 63.6%, and 38.5% of the patients with grade-II, -III, and -IV PD, respectively, were able to walk at the one-year follow-up, compared to 73.3% of the patients without PD. CONCLUSION. Surgical treatment for hip fractures was appropriate for patients with grade-II or -III PD.

Reoperation Rate After Internal Fixation of Intertrochanteric Femur Fractures With the Percutaneous Compression Plate

The aim was this study was to analyze the risk factors for reoperation after internal fixation of intertrochanteric fractures of the femur using the percutaneous compression plate (PCCP). This was a retrospective cohort study. The study was conducted at the University Hospital. Patients with intertrochanteric femur fractures who underwent internal fixation with a PCCP were included in this study. We investigated potential risk factors such as age, gender, body mass index, comorbidities of the patients (American Society of Anesthetist classification), type of fracture (AO/OTA classification), experience of the surgeons (in terms of the number of surgical procedures with the PCCP device), tip-apex distance (TAD), and operation time. The procedures were performed by 10 surgeons. Logistic regression was used to assess potential predictors for the need of reoperation. Of the 96 patients with 96 intertrochanteric fractures, 8 underwent reoperation due to local complications (8.3%). The most frequent complication was complete or imminent cutting out of the upper cervical screw (N = 5; 5.2%). Five of the 8 risk factors that were associated with reoperation in the initial univariable analyses with a P value of <0.20 were retained in a multivariable logistic regression model, including, age, body mass index, TAD, experience of the surgeons, and operation time. Of these, only the factor TAD proved to be a significant predictor for reoperation (P = 0.027, odds ratio = 1.089, 95% confidence interval 1.01-1.175). Our data show that the surgeon-related risk factors (number of operations, operation time, TAD) seem to be more relevant for the reoperation rate after internal fixation with the PCCP device when compared with the patient-related risk factors. This finding indicates a substantial learning curve for this technically demanding procedure. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Clinical outcome of endoprosthetic replacement for failed treatment of intertrochanteric fractures: A retrospective case series

The treatment methods for the failed internal fixation in elderly patients suffering from several osteoporostic fractures are still inconclusive. We aimed to evaluate the clinical effects of endoprosthetic replacement for failure treatment of intertrochanteric fracture. A total of 13 patients with failed internal fixation for intertrochanteric fracture were collected between January 2002 and October 2009. All of them were treated with endoprosthetic replacement and followed up till October 2010. Four of them received total hip replacement and the remained nine received artificial bipolar femoral head replacement. Clinical and functional outcomes of patients were assessed. Of 13 patients, nine were females and four were males with the mean age of 76.5 years (SD, 11.7, range, 58-92 years) at the time of fracture. The average time of operation and follow-up was 124 minutes (89-187minutes) and 31 months (14-68 months), respectively. The average blood loss during the operation was 631 ml (450-1560 ml). All patients showed good pain relief and functional improvement. Final post-operative Harris and WOMAC scores were significantly improved from pre-operative levels (P<0.05). Only five patients showed operative complications. Our finding indicated that endoprosthetic replacement is an effective salvage procedure for failed internal fixation of intertrochanteric fracture in elderly patients with effective pain relief and functional improvement as well as few serious complications.

Risk evaluation of failed internal fixation for intertrochanteric fracture

Objective To analyze and summarize the risk factors of failed internal fixation for intertrochanteric fracture.Methods From April 2008 to April 2011,267 patients with intertrochanteric fractures in 4 hospitals were treated with internal fixation.The relationship between the failure of internal failure and possible factors as age,gender,hypertension,diabetes,the abuse of alcohol and tobacco,use of glucocorticoid,the degree of osteoporosis and fractures type were studied.According to the surgical risk assessment table,the patients were divided into low-risk,mid-risk,and high-risk group.The rate of internal fixation failure was compared in the 3 groups.Results We found 42 cases which showed radiographic failures.The internal fixation failure directly related with advanced age,diabetes,severe osteoporosis,unstable type fracture,but not gender,hypertension,the abuse of alcohol and tobacco,use of glucocorticoid.Risk factors of internal fixation failure included diabetes,osteoporosis degree,and fracture stability.Failed intertrochanteric fracture fixation mainly occurred in the mid-risk and high-risk groups.Conclusion Severe osteoporosis,unstable fracture,diabetes are risk factors of failure of intertrochanteric fracture fixation.These factors will affect the quality of surgery.For the patient with intertrochanteric fractures in the low-risk groups,internal fixation should be the first choice for treatment.For the patients in the mid-risk and high-risk group,internal fixation should be applied cautiously.For the aged patients in high-risk groups,hip arthroplasty is a wise option. Key words: Hip fractures; Fracture fixation; Treatment failure

Hip arthroplasty for failed internal fixation of intertrochanteric fractures

Objective To respectively analyze the results and complications of hip arthroplasty for failed intertrochanteric hip fractures treating with internal fixation.Methods From July 2004 to June 2006,32 patients(24 males and 8 females)were treated with hip arthroplasty after the failed internal fixation of intertrochanteric fractures.The mean age was 71 years(range,57-81 years)at the time of the hip arthroplasty.The average interval from fracture to arthroplasty was 40 months(range,5-70 months).Fifteen patients had been treated with sliding hip screw,10 with intramedullary nail,5 with plate and screws,2 with multiple screws.The failure modes were nonunion in 8 patients,implant cut out from the femoral head in 9,avascular necrosis of the femoral head in 7,and traumatic arthritis in 8 patients.Cemented stems were used in 12 hips,and uncemented stems in 20 hips.Standard prostheses were used in 25,long-stem prostheses in 7.Results Twenty-eight patients were followed up for a minimum of 4 years after the hip arthroplasty,with the mean period of 5 years(range,4-6 yeas).For these 28 patients,the average preoperative Harris Hip Score was 37(range,32-45),and 88(range,84-95)at the latest follow-up.The average acetabular inclination was 44°(range,42°-48°).No loosing was found in cotyloid components.Nine of 10 cemented femoral components had cementation rated as grade C,and 1 as grade A.Three had heterotopic bone six months postoperatively,and 2 were Brooker type Ⅱ,one was type Ⅲ.Conclusion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient. Key words: Arthroplasty,replacement,hip; Hip fractures; Treatment failure