Functional Outcome of Treatment after Failed Intertrochanteric Fracture Fixation
S Gnanasekaran, Muthu K Vaiyapuri, Amudha G Selvaraj, Vijaya A Sivaji, Rex Chandrabose
Dynamic hip screw and bone grafting, Exchange nailing and bone grafting, Hemiarthroplasty, Intertrochanteric fracture, Modified Harris Hip, Total hip replacement score, Visual analog scale score
Citation Information :
Gnanasekaran S, Vaiyapuri MK, Selvaraj AG, Sivaji VA, Chandrabose R. Functional Outcome of Treatment after Failed Intertrochanteric Fracture Fixation. 2023; 5 (2):79-85.
Background: Failed intertrochanteric (IT) fractures are the most common fractures seen in an elderly population. It causes more morbidity and mortality in old people. Hence fixation of failed IT fractures is necessary. The aim of our study is to assess the functional outcome of failed IT fracture fixation like a dynamic hip screw and bone grafting, total hip replacement (THR), hemiarthroplasty, and exchange nailing and bone grafting.
Materials and methods: It is a prospective study done between June 2020 and May 2022 in Rex Ortho Hospital. Our study consists of 57 patients who had IT fractures primarily fixed with anyone of the following—like proximal femoral nailing (PFN) and dynamic hip screw fixation, and then failed due to various reasons like unstable fracture pattern, poor reduction techniques, implant failure, or loosening. Patient functional outcomes were assessed by Modified Harris Hip Score (MHHS), and the pain was assessed by visual analog scale (VAS) score at regular intervals preoperatively (pre-op), 3 months, 6 months, and 1 year.
Results: Our study population comprised 27 males and 30 females with failed IT fractures. The average follow-up was 12–24 months. Out of 57 patients, 18 had cemented THR, 17 had a dynamic hip screw and bone grafting, 13 had cemented hemiarthroplasty, and nine patients had exchange nailing and bone grafting. At the end of 12 months, among 11 patients with cemented THR patients, three (27.2%) had excellent outcomes and eight (72.7%) had good outcomes. Among eight patients with dental bone graft (DHS) and bone grafting, six (75%) had good outcomes and two (25%) had fair outcomes. Among seven patients with cemented hemiarthroplasty, six (85.7%) had good outcomes and one (14.2%) had a fair outcome. Among nine patients with exchange nailing and bone grafting, two had good outcomes, and five had poor outcomes.
Out of refixation, 25 out of 26 nonunions were healed. One nonunion again went for nonunion, which was a case of exchange nailing and bone grafting, and had revision cemented hemiarthroplasty. All patients are free of pain. Two patients had hyponatremia postoperatively (post-op) and three patients had post-op pain due to hardware impingement, but they were ambulatory. One had a superficial wound infection and one had a greater trochanter (GT) fracture intraoperatively.
Conclusion: In the selected group of patients who had refixation with bone grafting in the young population, all had excellent outcomes. The elderly who underwent THR had an excellent outcome, and patients with bipolar hemiarthroplasty scored less. Thus, we recommended head-conserving surgery where ever possible, and if not THR, and last option being bipolar hemiarthroplasty.
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