Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients

PURPOSE: The aim of this study was to evaluate and report the new method with a cement augmented screw fixation again to treat the failed intertrochanteric fracture in elderly which were treated with ordinary compression hip screw initially. MATERIALS AND METHODS: From Mar. 1988 to May 2007, 10 patients (mean age 69 years) with the failed intertrochanteric fracture which were treated with initial hip screw, were treated with a cement augmented compression hip screw again. The mean follow-up after surgery was over 18 months. The cause of failure, the period upto the reoperation, the neck-shaft angle after the reoperation, the position of lag screw in the femoral head, and the degree of union at last follow-up were analyzed. The change in the functional hip capacity were evaluated by the classification of Clawson. RESULTS: Causes of failure were superior cutting-out in 6 cases, cortical anchorage failure in 3, and nonunion in one case. The period upto the reoperation was average 7.8 months. Valgus reduction of average 5.7degrees was achieved, and the positions of lag screw were postero-inferior in 6 cases, center in 3, infero-center in one case. We obtained complete union in 9 cases. The functional outcome showed moderate in 6 cases, good in 3 and poor degree in one case. CONCLUSION: Cement augmented compression hip screw treatment will possibly reduce cutting-out of screw and bring more stability in fixation for intertrochanteric fractures in old osteoporotic patients, as well, even in failed cases treated with initial compression hip screw, but proper selection of patients is important.

Birmingham Resurfacing Hip Joint Arthroplasty: Minimum 5 Year follow-up study

PURPOSE: We wanted to evaluate more than 5 years of the clinical follow-up results of Birmingham hip joint resurfacing arthroplasty. MATERIALS AND METHODS: 20 cases of Birmingham resurfacing arthroplasties were performed in 17 patients (8 males and 9 females) between August 2001 and April 2002. Eleven patients had avascular necrosis of the femoral head, nine had osteoarthritis and two had ankylosing spondylitis. All the patients could be followed-up and the mean age at the time of operation was 35.9 (range: 22~65) years. Clinical evaluation was done with using the Harrris hip score; the osteolysis, migration of the femoral component and acetabular cup, the presence of femoral neck fracture and the secondary changes around the components were evaluated according to the radiological follow up findings. RESULTS: The mean preoperative Harris hip score of 38 points was improved to 94 points at the time of the final follow-up. Complications developed in the avascular necrosis patients, in the two cases of femoral neck fracture and in one case of incomplete sciatic nerve palsy. There was no osteolysis or movement of the femoral cap, peg and acetabular cup on the radiological evaluation. Some degree of periacetabular osteoporosis and some change of the trabecular pattern were found in all cases due to the secondary change from mechanical stress. CONCLUSION: Birmingham resurfacing hip arthroplasty provided excellent clinical and radiological results, and especially in the osteoarthritis patients. Special concern might be needed for the patients with avascular necrosis of the femoral head and for protecting the sciatic nerve.