Introduction: Management for failed treatment of femoral intertrochanteric fracture using hip screw is a challenge for orthopaedic surgeons. Failure rates with an internal fixation range between 3% and 12%. The unfavourable factors include severe osteoporosis, unstable fracture geometry, improper placement of hip screw or nail, broken lateral wall, bone deformity, bone loss, associated greater and lesser trochanteric nonunion and repeated trauma. In this study, we reported the surgical outcomes of patients with concomitant failed internal fixation and operated by implant removal and hemiarthroplasties.
Materials and Methods: We treated 25 patients of failed hip screws in intertrochanteric femur fractures surgically by hemiarthroplasty. Mean age of patients in this study was 66.8 years. In all patients surgical exposure was done using Southern Moore approach. Greater trochanter and lesser trochanter reconstruction was done in select cases using tension band wiring and collared stem respectively. The limb length discrepancy of the previously operated limb was dealt by increasing the neck offset and the limb length was restored to as that of opposite normal limb. The hemiarthroplasties eliminated the pain from the destructed femoral head. Postoperatively patient were mobilised from day 8. The patients were advised full weight bearing from 3 weeks onwards. The patients were followed every 6 weeks for more than 1 year clinically and radiologically.
Results: All Patients were followed for more than 1 year and evaluated using Modified Harris Hip Score. Among these 25 patients, excellent/good results were seen in 21 patients (84%). No dislocation of hemiarthroplasty occurred during the postoperative follow-up. One of the patients, who remained bedridden even after surgery, developed decubitus ulcer on the back and was labelled as failure. One patient had shortening more than 2 cm due to sinking of prosthesis.
Conclusion: Hemiarthroplasty is a rational option to treat cases of failed intertrochanteric femur fractures.