Analysis of the Fixation Failure in Intertrochanteric Hip Fractures Treated with Hip Nailing

Jun-Dong Chang; Tae-Young Kim; Ji-Hyo Hwang; Seul-Ki Min; Je-Hyun Yoo

doi:10.12671/jkfs.2012.25.3.169

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Chang, Kim, Hwang, Min, and Yoo: Analysis of the Fixation Failure in Intertrochanteric Hip Fractures Treated with Hip Nailing

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(3): 169-176.

Published online: 16 July 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.3.169

Analysis of the Fixation Failure in Intertrochanteric Hip Fractures Treated with Hip Nailing

Jun-Dong Chang, M.D., Ph.D., Tae-Young Kim, M.D., Ji-Hyo Hwang, M.D., Ph.D., Seul-Ki Min, M.D., Je-Hyun Yoo, M.D., Ph.D.

Department of Orthopedic Surgery, Hallym University College of Medicine, Seoul, Korea.

Address reprint requests to: Je-Hyun Yoo, M.D., Ph.D. Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170-gil, Dongan-gu, Anyang 431-070, Korea. Tel: 82-31-380-3770, Fax: 82-31-382-1814, oships@hallym.ac.kr

Received 21 July 2011 Revised 25 November 2011 Accepted 20 May 2012

Abstract

Purpose

To analyze the patterns of and risk factors for fixation failure after hip nailing in intertrochanteric (IT) hip fractures.

Materials and Methods

Fourteen patients who sustained a fixation failure after hip nailing for IT hip fractures were enrolled in this study. The mean age at the index surgery was 74.5 years and the mean time to the fixation failure was 6.6 weeks. All of the serial radiographs up to the fixation failure and pre-operative 3-D computed tomography were analyzed.

Results

According to AO classification, there were 7 stable fractures and 7 unstable ones. Of the total of 14 cases, 10 showed a comminution of the greater trochanter tip and incomplete anatomical reduction of the medial and anterior cortex at the fracture site. Of the 10 cases with appropriate position of the lag screw within the femoral head, 9 showed a high pertrochanteric fracture (HPF) pattern. The mechanism of the fixation failure was rotation of the femoral head in 7 of 9 cases with HPF and varus collapse of the proximal fragment in 4 of the other 5 cases.

Conclusion

The HPF pattern, the comminution of the greater trochanter tip, and incomplete reduction of the medial and anterior cortex may be additional risk factors of fixation failure after treating IT hip fractures with hip nailing in.

Keywords: Femur, Intertrochanteric fracture, Hip nail, Fixation failure

Figures and Tables

Fig. 1

(A) Anteroposterior radiograph and (B) 3-D computed tomography demonstrating typical high pertrochanteric fracture (HPF). (C) Schematic drawing of HPF. Fractures that occur within the dotted line, regardless of lesser trochanteric fragment, are regarded as HPFs.

Fig. 2

The change in the neck-shaft angle on (A) anteroposterior or (B) lateral radiograph during the early follow-up period means varus or retroversion collapse with the change of the lag screw position, respectively, which causes reduction loss and lag screw cut-out.

Fig. 3

(A) Pre-operative radiograph and 3-D computed tomography of a 77-year-old female show a high pertrochanteric fracture with a lesser trochanteric fragment and the comminution of the greater trochanter tip classified as AO type A2.1.

(B) Post-operative radiographs show anatomical reduction with an appropriate lag screw position after hip nailing with a Gamma 3 nail.

(C) Post-operative 6-week radiographs show the rotation of the femoral head.

(D) Post-operative 3-month radiographs show the collapse of the proximal fragment due to the rotation of the femoral head.

(E) Post-operative 6-month radiographs finally show the varus collapse of the proximal fragment with the change of lag screw position within the femoral head.

Table 1

Demographics of 14 patients

BMD: Bone mineral density, PFNA: Proximal femoral nail antirotation, ITST: Intertrochanteric-subtrochanteric nail.

Table 2

The peri-operative radiologic data of 14 patients with fixation failure

GT: Greater trochanter, HPF: High pertrochanteric fracture, LS: Lag screw, FH: Femoral head, AP: Anteroposterior, M: Medial to trochanteric tip, T: Trochanteric tip, L: Lateral to trochanteric tip.

Table 3

The radiologic results of 14 patients at time of fixation failure

LS: Lag screw, BHA: Bipolar hemiarthroplasty, THA: Total hip arthroplasty.

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