Analysis and Management of Failed Intertrochanteric Fracture Fixation

ABSTRACT

PURPOSE: We wanted to analyze the causes of fixation failure after performing compression hip screw fixation for intertrochanteric fracture and we wanted to evaluate the methods to mange this type of failure. MATERIALS AND METHODS: From January 1999 to August 2005, 15 patients who underwent operation due to fixation failure after compression hip screw fixation for intertrochanteric fracture were evaluated, with at least 1 year follow up, for the fracture type, the status of the reduction, the aspects of failure, the causes of the failure and the clinical and radiologic results after operation. RESULTS: There were 7 cases of cut out by the hip screw, 1 case of hip screw breakage, 1 case of dislodging the hip screw, 2 cases of excessive sliding of the hip screw, 2 cases of plate breakage and 2 cases of fixation loss of the plate. The failure of cases was due to incorrect choice of the implants, and that of 9 cases was due to technical error. The Harris Hip score was an average of 67.8 for 10 cases of failed arthroplasty at the last follow up and 88.4 for 4 cases of re-fixation with a 95 degree angled blade plate, and bone union was achieved at a minimum of 5 months. CONCLUSION: It is important to choose an adequate implant and a precise technique to achieve a successful result for fixation of unstable intertrochanteric fracture, and refixation with a 95 degree angled blade plate could be considered for the management of failed intertrochanteric fracture with arthroplasty.