Effect of hip joint replacement on the femoral intertrochanteric fracture with failed internal fixation / 中华创伤杂志

ABSTRACT

Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement.