Revision strategy after failed primary operation for intertrochanteric fracture and progress in related research / 中华创伤骨科杂志

ABSTRACT

Intertrochanteric fracture is the most common hip fracture. Due to severe osteoporosis and high degree of fracture comminution, initial implant failure or nonunion occasionally occurs. It is still controversial how to formulate a more effective strategy for revision and fixation after failed primary operation for patients who have high functional needs and/or long-life expectancy. Common surgical procedures include angle-stabilized extramedullary plate systems (dynamic condylar screw or dynamic hip screw), cephalomedullary nail systems (proximal femoral nail antirotation, InterTAN, and trochanteric fixation nail advanced) with/without medial augmentation plate. For patients with intertrochanteric fracture who have suffered from primary operation failure, the basic principle for revision is to mechanically reconstruct the stable triangular structure of the proximal femur in order to improve the mechanical stability of the fracture ends as much as possible so that fracture healing and early functional exercise can be ensured. This paper reviews the clinical and biomechanical studies published, analyzes the mechanical factors responsible for failure of initial surgery, summarizes revision strategy and clinical prognosis, and provides our clinical experience and technical innovations, hoping to help clinicians in choosing an optimal revision strategy.