Salvage of failed trochanteric and subtrochanteric fractures using a distally fixed, modular, uncemented hip revision stem

Figures & data

A subtrochanteric fracture treated with internal fixation (A and B). Due to migration of the screw into the pelvis (C), a THA was performed 1.5 months after the first operation (D). 1 year after the index operation, the subtrochanteric fracture appeared to have healed without any major subsidence of the stem (E).

Table 1. Baseline characteristics of the 30 patients

Type of femoral fracture
Trochanteric	10
Subtrochanteric	20
Fracture classification
Jensen-Michaelsen
1 / 2 / 3 / 4 / 5	1 / 2 / 0 / 2 / 5
Seinsheimer ^a
1 / 2a / 2b / 2c	0 / 0 / 0 / 0
3a / 3b / 4 / 5	3 / 0 / 1 / 12
AO/OTA ^a
31, A1.1 / A1.2 / A1.3	1 / 2 / 0
31, A2.1 / A2.2 / A2.3	1 / 1 / 5
31, A3.1 / A3.2 / A3.3	1 / 0 / 0
32, A1.1 / A2.1 / A3.1	0 / 1 / 0
32, B1.1 / B2.1 / B3.1	8 / 6 / 0
Implant (primary internal fixation)
Sliding hip screw	7
Short intramedullary nail	12
Long intramedullary nail	9
Other	2
Modes of failure (primary internal fixation)
Cutout (femoral neck screw)	12
Migration (femoral neck screw)	9
Implant breakage	3
Disassembly	1
Other	5
Frequency of operations before index operation
1 / 2 / 3 / 4	17 / 8 / 4 / 1

^a 4 preoperative radiographs missing.

AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association.

Table 2. Radiographic outcome (n = 30)

Union of fracture
Yes	26
No	4
Proximal bone defects
Restoration	16
No change	11
Increasing	3
Distal stem migration (mm)
Mean (SD)	2 (3)
Subsidence (migration > 5 mm)
Yes	4
No	26
Stem fixation
Bone ingrowth	25
Stable fibrous	3
Unstable	–
Not possible to identify	2
Heterotopic ossification
0 / 1 / 2 / 3
Index operation	19 / 6 / 3 / 2
Follow-up	16 / 5 / 4 / 5