Salvage Re-Fixation for the Failed Fixation of Pertrochanteric Fracture

Kyung-Jae Lee; Byung-Woo Min; Ki-Cheor Bae; Dong-Hu Kim; Kyoung-Lag Lee

doi:10.12671/jkfs.2013.26.2.105

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Lee, Min, Bae, Kim, and Lee: Salvage Re-Fixation for the Failed Fixation of Pertrochanteric Fracture

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2013; 26(2): 105-111.

Published online: 22 April 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.2.105

Salvage Re-Fixation for the Failed Fixation of Pertrochanteric Fracture

Kyung-Jae Lee, M.D., Byung-Woo Min, M.D., Ki-Cheor Bae, M.D., Dong-Hu Kim, M.D., Kyoung-Lag Lee, M.D.

Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Address reprint requests to: Byung-Woo Min, M.D. Department of Orthopedic Surgery, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel: 82-53-250-7267, Fax: 82-53-250-7205, min@dsmc.or.kr

Received 12 October 2012 Revised 24 November 2012 Accepted 24 November 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

The purpose of this study is to evaluate the clinical and radiological result in patients who got salvage re-fixation for the failed fixation of pertrochanteric fracture retrospectively.

Materials and Methods

Between 1992 and 2009, 21 patients who could be followed-up for more than 1 year after salvage re-fixation for the failed fixation of pertrochanteric fracture were enrolled in this study. There were 16 men and 5 women. The mean age was 53 years (19-84 years) at the index surgery and the mean follow-up was 6.4 years. We evaluated the clinical and radiographic results and postoperative complications.

Results

Walking ability and pain were improved in all cases and the mean leg length discrepancy was improved from 2.5 cm (0-10 cm) preoperatively to 1 cm (0-4 cm) at the latest follow-up. Nineteen patients (90.5%) out of 21 patients achieved bony union at the final evaluation and the mean union time was 4 months (3-7 months). There were 2 cases of non-union who had not received bone graft as a complication.

Conclusion

The clinical and radiological results of the salvage re-fixation for the failed fixation of pertrchanteric fracture were satisfactory in our study. Secure component fixation for the mechanical stability and proper bone graft for the improvement of bone biology are mandatory to improve the result.

Keywords: Femur, Trochanter, Fracture, Re-fixation, Bone graft

Figures and Tables

Fig. 1

A diagram shows author's treatment algorism for the failed fixation of pertrochanteric fracture. DHS: Dynamic hip screw, IM: Intramudullary.

Fig. 2

A 64-years-old male with left hip pain.

(A) Preoperative radiograph shows the non-union of pertrochanteric fracture with broken angle blade plate.

(B) Immediate postoperative radiograph shows dynamic hip screw fixation due to the inferior head defect. During the re-fixation, bone graft was added due to the bone defect on the non-union site.

(C) Radiograph after one year shows solid fracture union.

Fig. 3

A 69-years-old male with left hip pain.

(A) Preoperative radiograph shows infected non-union of fracture site with large bone defect.

(B) After infection control, 90 degree angle blade plate was used due to the superior head defect. During the re-fixation, bone graft was done.

(C) One year after the operation, the fracture site was well united.

Table 1

Aspects of Primary Fixation Failure

Table 2

Change of Walking Ability

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