The reasons of internal fixation failure for subtrochanteric fractures of the femur
- VernacularTitle:股骨转子下骨折内固定失败原因分析
- Author:
Xiang XIAO
;
Tieliang ZHANG
- Publication Type:Journal Article
- Keywords:
Femoral fractures;
Hip fractures;
Internal fixators;
Postoperative complications
- From:
Chinese Journal of Orthopaedics
2001;0(03):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the reasons of internal fixation failure for subtrochanteric fractures of the femur and indicate the methods for avoiding the complications. Methods Thirty-nine patients with internal fixation failure for subtrochanteric fractures of the femur were treated from January 1993 to January 2004. There are 34 males and 5 females with an average age of 37 years (range from 21 to 65 years). The causes of injury included falls from bicycle in 3 cases, pedestrain injury in 1 case, traffic accident in 28 cases and falls from heights in 7 cases. The pattern of the fractures included Seinsheimer ⅡA type in 5 cases,ⅡB type in 2 cases,ⅡC type in 1 case,ⅢA type in 18 cases,ⅢB type in 1 case,Ⅳ type in 3 cases,Ⅴ type in 9 cases. The initial operation included open reduction and fixed with cerclage wires in 1 case, open reduction and fixed with Kuntscher nail and cerclage wire in 13 cases, closed reduction and fixed with Russell-Taylor reconstruction nail in 1 case, open reduction and fixed with 135? DHS in 6 cases, open reduction and fixed with plate in 18 cases. Two cases failed in 8 weeks postoperation, 26 cases failed in 6 months postoperation and 11 cases failed over 6 months. The pattern of failure of internal fixation include varus deformity of fracture in 35 cases, cutout of the lag screw from the femoral head in 2 cases and over medial migration of the distal femoral shaft in 2 cases. The reasons of internal fixation failure were nonanatomically reduction of fractures, unrigid interal fixation, over early weight bearing and poor placement of lag screw. Results The internal fixtion of fractures were revised, including open reduction and fixed with kuntscher nail in 2 cases, fixed with interlocking nail in 23 cases, fixed with 135? DHS in 6 cases, fix with plate in 4 cases, total hip replacement in 4 cases. The mean duration of follow up was 23 months (range from 19 to 37 months). The average time of fracture healing was 11.5 months (range from 11 to 13 months). Conclusion There are higher bending loads at the subtrochanteric area of the femur due to the eccentric loading. If extramedullary implant is selected, the stability at the medial cortex of the femur must be reconstructed intraoperatively and bone grafting is required.
