Archives of Orthopaedic and Trauma Surgery

, Volume 113, Issue 4, pp 222–227

Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient

  • P. Haentjens
  • P. P. Casteleyn
  • P. Opdecam
Clinical and Experimental Forum


Nine elderly patients were treated by salvage hip arthroplasty following failed internal fixation of an intertrochanteric or subtrochanteric hip fracture. The mean age at time of fracture was 79 years (range 67–94 years). The mean interval from initial fracture fixation to conversion arthroplasty was 7 months (range 5 days to 19 months). One 84-year-old patient died 6 weeks postoperatively from a pulmonary infection. The remaining eight patients were assessed clinically and roentgenographically after a mean follow-up period of 41 months (range 4–85 months). The functional results, rated according to the Merle d'Aubigné hip rating scale, were excellent in one patient, very good in four patients, good in two patients, and fair in one patient. Serial roentgenographic analysis showed new bone formation around the extramedullary part of the femoral component in all these patients and bone remodelling of the diaphyseal part of the femur in all patients. The preservation of the functional continuity of the abduction apparatus during surgery and the early walking with full unrestricted weight-bearing made possible by the arthroplasty are considered to be the major contributing factors to these results.


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  1. 1.
    Baker HR (1960) Ununited intertrochanteric fractures of the femur. Clin Orthop 18:209–220Google Scholar
  2. 2.
    Blunn GW, Wait ME (1990) A comparison of the fixation of custom-made prosthesis with the fixation of standard joint replacements. In: Oldner J (ed) Implant bone interface. Springer, Berlin Heidelberg New York, pp 151–161Google Scholar
  3. 3.
    Boyd HB, Lipinski SW (1957) Nonunion of trochanteric and subtrochanteric fractures. Surg Gynecol Obstet 104:463–470Google Scholar
  4. 4.
    Evans EM (1949) The treatment of trochanteric fractures of the femur. J Bone Joint Surg [Br] 31-B: 190–203Google Scholar
  5. 5.
    Ganz R, Thomas RJ, Hammerle CP (1979) Trochanteric fractures of the femur. Treatment and results. Clin Orthop 138: 30–40Google Scholar
  6. 6.
    Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P (1989) Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. J Bone Joint Surg [Am] 71-A:1214–1225Google Scholar
  7. 7.
    Hägglund G, Nordström G, Lindgren L (1984) Total hip replacement after nailing failure in femoral neck fracture. Arch Orthop Trauma Surg 103:125–127Google Scholar
  8. 8.
    Jensen JS (1980) Classifications of trochanteric fractures. Acta Orthop Scand 51:803–810Google Scholar
  9. 9.
    Johnson J (1984) Comparison between hemiarthroplasty and total hip replacement following failure of nailed femoral neck fractures focused on dislocation. Arch Orthop Trauma Surg 102:187–190Google Scholar
  10. 10.
    Knight WM, De Lee JC (1982) Nonunion of intertrochanteric fractures of the hip: a case study and review. Orthop Trans 16 438Google Scholar
  11. 11.
    Lifeso R, Younge D (1990) The neglected hip fracture. J Orthop Trauma 4:287–292Google Scholar
  12. 12.
    Mariani EM, Rand JA (1987) Nonunion of intertrochanteric fracture of the femur following open reduction and internal fixation. Clin Orthop 218:81–89Google Scholar
  13. 13.
    Mehlhoff T, Landon GC, Tullos HS (1991) Total hip arthroplasty following failed internal fixation of hip fractures. Clin Orthop 269:32–37Google Scholar
  14. 14.
    Mercati E, Guary A, Miquel L, Bourgeon A (1972) Une voie d'abord postéro-externe de la hanche. Inter & de la réalisation d'un muscle “digastrique”. J Chir (Paris) 103:499–504Google Scholar
  15. 15.
    Merle d'Aubigné R (1970) Cotation chiffrée de la fonction de la hanche. Rev Chir Orthop 56:481–486Google Scholar
  16. 16.
    Meyers MH (1985) Delayed union, nonunion and malunion of hip fractures. In: Meyers MH (ed) Fractures of the hip. Year Book Medical, Chicago, pp 343–353Google Scholar
  17. 17.
    Schatzker J, Tile M (1987) The rationale of operative fracture care. Springer, Berlin Heidelberg, New York, pp 217–234Google Scholar
  18. 18.
    Schneider R (1980) Die Armierung der Pfanne bei der Totalendoprothese der Hüfte. Unfallheilkunde 83:482–488Google Scholar
  19. 19.
    Schneider R (1982) Die Krückstockprothese.In: Schneider R (ed) Die Total-Prothese der Hüfte. Ein biomechanisches Konzept und seine Konsequenzen. Huber, Bern, pp 237–246Google Scholar
  20. 20.
    Seinsheimer F (1978) III: Subtrochanteric fractures of the femur. J Bone Joint Surg [Am] 60-A:300–306Google Scholar
  21. 21.
    Wroblewski BM (1990) Infection. In: Wroblewski BM (ed) Revision surgery in total hip arthroplasty. Springer, New York Berlin Heidelberg, pp 47–61Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • P. Haentjens
    • 1
  • P. P. Casteleyn
    • 1
  • P. Opdecam
    • 1
  1. 1.Department of Orthopaedics and Traumatology, Academisch Ziekenhuis V.U.B.Vrije Universiteit BrusselBrusselsBelgium

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