Multiple cervicodiaphyseal angles are available for fixation of the proximal bone fragment according to the preoperative plan. Fixed angle devices, such as angled blade plates and dynamic condylar screws (DCSs), are preferred and often accompanied by autogenous bone grafting. The bone stock of the inferior femoral head has usually not been violated by the prior device. Implants used for revision internal fixation are typically selected according to the quality and location of the remaining bone stock of the proximal femur. In this regard, orthopedic surgeons should spare no effort to preserve native bone and achieve fracture union with this procedure, especially in active patients younger than 50 years of age. Unlike hip arthroplasty, which is characterized by limited longevity, revision internal fixation preserves the femoral head thus, further revision surgery due to prosthesis abrasion is unnecessary. However, open reduction and revision internal fixation with or without osteotomy or bone grafting have been reported to achieve high union rates and few complications. In this review, we discuss novel strategies regarding salvage options and surgical techniques to improve the outcome of patients with failed internal fixations of IT fractures.įull size image Femoral head salvage proceduresįailure of fixation of IT fractures in young patients is exceedingly rare. Accordingly, management of these cases has been reported with increased risks of perioperative morbidity, prolonged operative times, escalated blood loss, frequent intraoperative fracture, and a high rate of early dislocation. Several technical hurdles emerge in this situation, including residual bone deformity, distorted soft tissue anatomy, broken implants, poor bone stock, and femoral deficiency. Salvage osteosynthesis and conversion hip arthroplasty remain the mainstays of treatment for the failed internal fixation of IT fractures rather than conservative, nonoperative therapy, which is limited to incredibly infirm patients. Surgery indications include implant failure, nonunion, malunion, fracture, dislocation, femoral head necrosis, posttraumatic arthritis and infection. Failed treatment of IT fractures leads to remarkable disability and pain, which may cause complications associated with prolonged recumbency and affect the vital prognosis of these fragile patients, thereby necessitating effective surgical intervention. Although most IT fractures can be treated successfully with contemporary surgical techniques and internal fixations such as intramedullary nails and sliding hip screws, clinical failures still occasionally occur, with reported data indicating a range from 0.5 to 56% depending on the fracture type, patient status, and quality of the reduction and fixation. Intertrochanteric (IT) fractures are common, accounting for almost half of all hip fractures and resulting in a great burden on orthopedic services. 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. 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. 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. ![]() 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. ![]() There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. ![]() 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.
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