J Korean Fract Soc.  2013 Apr;26(2):105-111. 10.12671/jkfs.2013.26.2.105.

Salvage Re-Fixation for the Failed Fixation of Pertrochanteric Fracture

• Lee KJ
• Min BW
• Bae KC
• Kim DH
• Lee KL

• KMID: 1496164
• DOI: http://doi.org/10.12671/jkfs.2013.26.2.105

Abstract

PURPOSE
The purpose of this study is to evaluate the clinical and radiological result in patients who got salvage re-fixation for the failed fixation of pertrochanteric fracture retrospectively.
MATERIALS AND METHODS
Between 1992 and 2009, 21 patients who could be followed-up for more than 1 year after salvage re-fixation for the failed fixation of pertrochanteric fracture were enrolled in this study. There were 16 men and 5 women. The mean age was 53 years (19-84 years) at the index surgery and the mean follow-up was 6.4 years. We evaluated the clinical and radiographic results and postoperative complications.
RESULTS
Walking ability and pain were improved in all cases and the mean leg length discrepancy was improved from 2.5 cm (0-10 cm) preoperatively to 1 cm (0-4 cm) at the latest follow-up. Nineteen patients (90.5%) out of 21 patients achieved bony union at the final evaluation and the mean union time was 4 months (3-7 months). There were 2 cases of non-union who had not received bone graft as a complication.
CONCLUSION
The clinical and radiological results of the salvage re-fixation for the failed fixation of pertrchanteric fracture were satisfactory in our study. Secure component fixation for the mechanical stability and proper bone graft for the improvement of bone biology are mandatory to improve the result.

Keyword

Femur; Trochanter; Fracture; Re-fixation; Bone graft

MeSH Terms

Biology
Female
Femur
Follow-Up Studies
Humans
Leg
Male
Transplants
Walking

Figure

• 

  Fig. 1 A diagram shows author's treatment algorism for the failed fixation of pertrochanteric fracture. DHS: Dynamic hip screw, IM: Intramudullary.

• 

  Fig. 2 A 64-years-old male with left hip pain. (A) Preoperative radiograph shows the non-union of pertrochanteric fracture with broken angle blade plate. (B) Immediate postoperative radiograph shows dynamic hip screw fixation due to the inferior head defect. During the re-fixation, bone graft was added due to the bone defect on the non-union site. (C) Radiograph after one year shows solid fracture union.

• 

  Fig. 3 A 69-years-old male with left hip pain. (A) Preoperative radiograph shows infected non-union of fracture site with large bone defect. (B) After infection control, 90 degree angle blade plate was used due to the superior head defect. During the re-fixation, bone graft was done. (C) One year after the operation, the fracture site was well united.

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