Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art
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Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art Pei Liu, Dongxu Jin, Changqing Zhang* and Youshui Gao*
Abstract Failed treatment of intertrochanteric (IT) femoral fractures leads to remarkable disability and pain, and revision surgery is frequently accompanied by higher complication and reoperation rates than primary internal fixation or primary hip arthroplasty. There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. Salvage options are determined according to patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency. In physiologically young patients, care should be taken to preserve the vitality of the femoral head with salvage internal fixation; however, for the elderly population, conversion arthroplasty can result in early weight bearing and ambulation and eliminates the risks of delayed fracture healing. Technical challenges include a difficult surgical exposure, removal of broken implants, deformity correction, critical bone defects, poor bone quality, high perioperative fracture risk, and prolonged immobilization. Overall, the salvage of failed internal fixations of IT fractures with properly selected implants and profound techniques can lead to the formulation of valuable surgical strategies and provide patients with satisfactory clinical outcomes. Keywords: Intertrochanteric femoral fracture, Hip fracture, Revision surgery, Failed fracture fixation, Salvage internal fixation
Background Intertrochanteric (IT) fractures are common, accounting for almost half of all hip fractures and resulting in a great burden on orthopedic services [1–3]. Although most IT fractures can be treated successfully with contemporary surgical techniques and internal fixations such as intramedullary nails and sliding hip screws, clinical failures still occasionally occur, with reported data indicating a range from 0.5 to 56% depending on the fracture type, patient status, and quality of the reduction and fixation [4–9]. Failed treatment of IT fractures leads to remarkable disability and pain, which may cause complications associated with prolonged recumbency and * Correspondence: [email protected]; [email protected] Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Xuhui, Shanghai 200233, China
affect the vital prognosis of these fragile patients, thereby necessitating effective surgical intervention [10]. Surgery indications include implant failure, nonunion, malunion, fracture, dislocation, femoral head necrosis, posttraumatic arthritis and infection [4, 11, 12]. Salvage osteosynthesis and conversion hip arthroplasty remain the mainstays of treatment for the failed internal fixation of IT fractures rather than conservative, nonoperative therapy, which is limited to incredibly infirm patients [13]
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