Salvage of failed internal fixation of intertrochanteric hip fractures

Most intertrochanteric hip fractures treated with internal fixation heal. If nonunion or early loss of fracture fixation occurs, treatment options include prosthetic replacement and revision internal fixation. The purpose of the current study was to evaluate the results of revision internal fixation and bone grafting for salvage of failed internal fixation of intertrochanteric hip fractures. Between 1981 and 2000, 20 patients with 20 intertrochanteric fractures who had initial internal fixation that failed were treated with revision open reduction and internal fixation and bone grafting. The mean age of the patients was 58 years (range, 21-86 years). The mean clinical followup was 27 months (range, 3-120 months), and mean radiographic followup was 22 months (range, 3-120 months). Eleven patients were treated with an angled blade plate (seven, 95degrees; two, 90degrees; one, 110degrees; and one, Harris blade plate), five with a dynamic hip screw, three with a dynamic condylar screw, and one with a Zickel nail. Autograft bone was used in 17 patients and allograft bone was used in three patients. Nineteen of 20 nonunions healed (95%). Sixteen of the 19 patients who achieved healing reported no pain and three had mild pain (related to retained hardware); all were ambulatory. Two patients had perioperative complications (10%): one wound dehiscence, and one severe hyponatremia. In properly selected patients, revision internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.