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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
ORTHOPEDIC TRAUMA UPDATE PARTE II
Minerva Ortopedica e Traumatologica 2009 December;60(6):571-82
Hip arthroplasty in the treatment of subtrochanteric fracture and nonunion
Talmo C. T., Weiss E., Bono J. V.
New England Baptist Hospital, Boston, MA, USA
Traditionally, peritrochanteric hip fractures including subtrochanteric fractures have been treated with open reduction and internal fixation with screw plate devices such as the dynamic hip screw (DHS) or the dynamic condylar screw (DCS) or the cephalomedullary nail. Telescoping screws such as the DHS allow fracture impaction with weight-bearing and this may increase the stability of the construct in intertrochanteric fractures, however, this may also lead to displacement and mechanical failure when the fracture extends into the subtrochanteric region. The cephalomedullary nail provides better load sharing in the proximal femur and have gained more recent popularity and support, however, they are also subject to nonunion and mechanical failure in patients with severe osteopenia. Patients with severe symptomatic osteoarthritis of the hip who sustain a fracture of the proximal femur are likely to experience poor functional recovery following internal fixation and are likely to require subsequent conversion surgery. In nonarthritic hips acute hemi- or total hip arthroplasty may be considered with reasonably good results if mechanical failure seems predictable due to poor bonestock or a very unstable fracture pattern. When these internal fixation devices fail or nonunion arises in the elderly population and those with poor bone-stock, hip arthroplasty is a reasonable option for salvage. In addition, select patients at a high risk of clinical failure from intertrochanteric or subtrochanteric fracture may be candidates for primary arthroplasty. In this report we describe a surgical technique for arthroplasty salvage of peritrochanteric fractures and nonunions which preserves maximal bonestock with a low risk of postoperative dislocation.