Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture

Introduction: Management for failed hip screw after femoral intertrochanteric fracture is a challenge for orthopaedic surgeons. The unfavorable factors include severe osteoporosis, unstable fracture geometry, improper placement of hip screw, and repeated trauma. Except revision fixation of the fractures, arthroplasty may be indicated in case of destructed femoral head. In this study, we reported the surgical outcomes of patients with concomitant failed hip screws and fractures of greater trochanter operated by hemi-arthroplasties. Materials and methods: We treated 16 patients of failed hip screws with concomitant fracture of greater trochanter surgically by hemi-arthroplasty and cable-grip system from January 2001 to December 2004. The reattachment of greater trochanter by cable-grip system enhanced abductor mechanism to reduce the dislocation rate of hip arthroplasty. The hemi-arthroplasties eliminated the pain from the destructed femoral head. Partial weight bearing was allowed postoperatively. The patients were followed every 6 weeks clinically and radiologically. Full weight bearing was not allowed until solid bony union was seen on the plain radiographs. Results: Among these 16 patients, all patients achieved solid union of greater trochanter except one by 24 weeks postoperatively. No postoperative wound infection was found. No dislocation of hemi-arthroplasty occurred during the postoperative follow-up. The clinical assessment based on SF-36 questionnaire improved from 41.9 to 82.7. Conclusion: Hemi-arthroplasty with supplemental fixation of greater trochanter is a rational option to treat failed hip screws with fracture of greater trochanter in case of destructed femoral head.