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

Joon Soon Kang; Ryuh Sup Kim; Bom Soo Kim; Young Tae Kim; Seung Hyun Hong

doi:10.12671/jkfs.2012.25.4.263

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Kang, Kim, Kim, Kim, and Hong: Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(4): 263-268.

Published online: 19 October 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.4.263

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

Joon Soon Kang, M.D., Ryuh Sup Kim, M.D., Bom Soo Kim, M.D., Young Tae Kim, M.D., Seung Hyun Hong, M.D.

Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea.

Address reprint requests to: Joon Soon Kang, M.D. Department of Orthopedic Surgery, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: 82-32-890-2380, Fax: 82-32-890-2387, kangjoon@inha.ac.kr

Received 11 January 2012 Revised 14 February 2012 Accepted 7 June 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Femur, Hip fracture, Fixation failure, Nonunion

Figures and Tables

Fig. 1

Relationship between position of dynamic screw and failure.

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.

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.

Table 1

Relationship between Age and Failure

Values are presented as number or number (%).

Table 2

Relationship between TAD and Failure

Values are presented as number or number (%). TAD: Tip to apex distance.

Table 3

Relationship between PFM and Failure

Values are presented as number or number (%). PFM: Posteromedial fragment.

Table 4

Relationship between Axial Displacement and Failure

Values are presented as number or number (%).

Table 5

Relationship between Axial Angulation and Failure

Values are presented as number or number (%). AD: Anterior displacement.

Table 6

Relationship between Axial Neck Shaft Angle and Failure

Values are presented as number or number (%).

Table 7

Relationship between Quality of Reduction and Failure

Values are presented as number or number (%).

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