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German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Replacement for failed dynamic hip screw fixation of intertrochanteric fractures

Meeting Abstract

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  • presenting/speaker Afshin Taheriazam - Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
  • Farshad Safdari - Bone, Joint and related tissues research center, Shahid Beheshti University of medical sciences, Tehran, Iran

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO13-1457

doi: 10.3205/17dkou638, urn:nbn:de:0183-17dkou6384

Published: October 23, 2017

© 2017 Taheriazam et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Failure of intertrochanteric fracture fixation often occurs in patients, who have poor bone quality, severe osteoporosis, or unstable fracture patterns. Hip arthroplasty is a good replacement procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. The purpose of this study is to evaluate the outcomes of total hip arthroplasty (THA) as the replacement for failed fixation of intertrochanteric fractures of the femur.

Methods: 203 patients of failed intertrochanteric fractures between April 2009 and October 2014 were included in the study. All of them underwent total hip arthroplasty through direct lateral approach. 150 patients were male (73.8%) and 53 patients (26.1%) were female and the mean of age was 59.02±10.34 years old (range: 56-90 years). The indications of the failure were nail cut out in 174 (85.7%), non-union in 15 (7.3%), plate failure in 14 cases (6.8%). One patient underwent two-stage protocol due to infection. We evaluated the possible clinical and radiological complications and measured functional outcome with modified Harris hip score (MHHS). We used cementless cup in nearly all of patients (95.2%), cementless long stem in 88.1% of patients.

Results and Conclusion: We followed patients for the mean time of 4.43±1.11 years (range 3-5 years). The mean (MHHS) was improved from 45.32±12.41 (range 40-49) to 89.37±7.41 (range 85-98) significantly (P=0.002). There was no infection, no reoperation, no dislocation, no nerve palsy, no avascular necrosis, no pulmonary embolism (PTE) and deep vein thrombosis (DVT). There was only one intra-operative fracture which was treated. All patients were ambulatory at the final follow up. There were no significant differences in hospital stay, operating time, and transfusion volume between the 2 groups (P>0.05).

We showed in a large population study that functional outcome can be achieved by hip arthroplasty excellently in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good replacement option for this patient group.