Hemiarthroplasty with Wagner SL prosthesis for failed internal fixation of intertrochanteric fractures in elderly patients / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical outcomes of hemiarthroplasty with Wagner SL prosthesis in treating failed internal fixation of intertrochanteric fractures of elderly patients.Methods Aretrospective 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.