J Korean Fract Soc.  2012 Oct;25(4):263-268. 10.12671/jkfs.2012.25.4.263.

Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture

• Kang JS
• Kim RS
• Kim BS
• Kim YT
• Hong SH

• KMID: 1434064
• DOI: http://doi.org/10.12671/jkfs.2012.25.4.263

Abstract

PURPOSE
To analyze the causes of internal fixation failure in elderly intertrochanteric femoral fractures.
MATERIALS AND METHODS
We retrospectively analyzed 93 intertrochanteric femoral fractures that were treated by internal fixation. The follow-up period was at least 24 months. The mean age was 73 years. We analyzed the classification of the fracture, screw position, reduction state of the fracture, and neck-shaft angle.
RESULTS
Internal fixation failure occurred in 12 cases (12.9%). The causes of internal fixation failure were one case (1.0%) of head perforation, 7 cases (7.5%) of excessive slippage of a screw, and 4 cases (4.3%) of varus deformity. Significant factors infixation failure were displacement of the posterolateral fragment more than 8 mm in anteroposterior radiograph, anterior displacement of a fragment, or more than 20-degree angulation in lateral radiography. Thirty-three cases had a screw in the middle position and 4 of these cases (12.1%) had fixation failure. Notably, 14 cases had a screw in the posteromedial position and 6 of these cases had fixation failure (42.8%).
CONCLUSION
Accurate reduction of the posteromedial fragment is essential in unstable intertrochanteric fracture and anterior displacement or angulation should be avoided to prevent fixation failure. The tip apex distance of the screw and central location of the screw in the femoral head is also an important factor.

Keyword

Femur; Hip fracture; Fixation failure; Nonunion

MeSH Terms

Aged
Congenital Abnormalities
Displacement (Psychology)
Femoral Fractures
Femur
Follow-Up Studies
Head
Humans
Retrospective Studies

Figure

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  Fig. 1 Relationship between position of dynamic screw and failure.

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  Fig. 2 Case of screw slippage and reoperation by using blade plate. (A) Preoperative radiography of 80-year-old female patient. (B) Immediate postoperative radiography showed a relatively acceptable reduction of the fracture. However a tip apex distance was not adequate. (C) Postoperative 3 months radiography showed a fixation failure. (D) Reoperation was performed with a blade plate and bone graft.

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  Fig. 3 Case of screw cutout and reoperation by using bipolar hemiarthroplasty. (A) Preoperative radiography of 78-year-old female patient. (B) Immediate postoperative radiograph. (C) At postoperative 2 months, fixation failure was noted. (D) Bipolar hemiarthroplasty was performed.

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