Search

Abstract Failed treatment of intertrochanteric (IT) femoral fractures leads to remarkable disability and pain, and revision surgery is frequently accompanied by higher complication and reoperation rates than primary internal fixation or primary hip arthroplasty. There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. Salvage options are determined according to patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency. In physiologically young patients, care should be taken to preserve the vitality of the femoral head with salvage internal fixation; however, for the elderly population, conversion arthroplasty can result in early weight bearing and ambulation and eliminates the risks of delayed fracture healing. Technical challenges include a difficult surgical exposure, removal of broken implants, deformity correction, critical bone defects, poor bone quality, high perioperative fracture risk, and prolonged immobilization. Overall, the salvage of failed internal fixations of IT fractures with properly selected implants and profound techniques can lead to the formulation of valuable surgical strategies and provide patients with satisfactory clinical outcomes.

Abstract: Objective: The current study aimed to perform a biomechanical analysis of the effect and distribution of stress and strain values in the femur and its residual screw holes from the implantation of different lengths of total hip prostheses following failed dynamic hip screw (DHS) fixation of AO type A1.1 and A1.3 intertrochanteric fractures. Methods: Medical image processing, computer-assisted engineering design, and finite element analysis were combined for the analysis and the reliability of the model confirmed by convergence testing and comparison with a physical model. Using finite element analysis, patterns of stress from implantation of total hip prostheses with different stem length were obtained. Results: Stress distribution was concentrated over the third and fourth residual screw holes, especially in the models with shorter stem length. Fracture type (AO type A1.1 or A1.3) did not alter its distribution. In proximal cancellous bone, a stress-shielding effect was seen at the region of the residual fracture fragment, especially in the A1.1 fracture. In the fracture fixed with 2 cable wires, the maximum von Mises stress was in the proximal cable wire. Conclusion: The results suggest that an increase in the original stem length equal to the diameter of the femoral isthmus, or a distance between the most distal residual screw hole and the end of the femoral prosthesis, provide improved stress distribution. [Copyright &y& Elsevier]

Total hip arthroplasty can be a very effective salvage treatment for both failed fracture surgery and hip arthritis that may occur after prior fracture surgery. The rate of complications is significantly increased including especially infection, dislocation, and loosening. Complications are more likely to occur after failed open reduction and internal fixation than after posttraumatic arthritis. Adequately ruling out infection before hip arthroplasty can be difficult. The best predictor of infection is a prior infection. Long-term outcomes can be comparable to outcomes in other conditions if complications are avoided., (Copyright © 2015 Elsevier Inc. All rights reserved.)