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Salvage procedure for cut-through after surgical fixation of trochanteric fractures with TFN

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Closed reduction and fixation using a cephalomedullary nail represents the accepted management of unstable intertrochanteric fractures. Cut-through has been described as a complication associated with the treatment. Although a hip arthroplasty may be the most predictable revision method, a non-prosthetic option can lead to similar results.

The objective is to describe a non-prosthetic revision procedure in cases of cut-through.

Method

We performed a retrospective analysis of our Institutional Registry for Hip Fractures in elderly patients (RIAFC) from January 2010 to June 2018 searching for cut-through as a failure after unstable intertrochanteric fracture treatment.

Revision procedure

(A) Helical blade removal, introduction of structural bone graft (autologous or allograft) as a plug to obliterate the communication to the joint and a new blade insertion.

(B) Same as in A but augmenting the blade/head purchase with poly(methyl methacrylate) (PMMA). Before the cement insertion, a radio-opaque solution was instilled to assure lack of joint leakage.

Results

We evaluated 1616 patients. Sixteen of them presented a cut-through complication (1%). Ten of them were females with an average age for all of 84 years. One patient denied an implant revision and opted for a total joint replacement. In four of the patients, the procedure A was done, 2 of them had a new failure, and an joint arthroplasty was performed. In the B group, only one patient needed a revision to a total hip. The other 10 patients healed uneventfully and did not need any further intervention.

Conclusion

Cut-through revision after fixation of unstable intertrochanteric fractures treated with cephalomedullary nail by blocking of the joint communication and augmenting the head blade purchase with PMMA is a safe and minimal invasive procedure, generates low blood loss and rate of complications and allows bone healing preserving the native joint.

Level of Evidence IV

Nil

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Authors and Affiliations

  1. Trauma Section, Instituto de Ortopedia Y Traumatología “Carlos E. Ottolenghi” Hospital Italiano de, Buenos Aires, Argentina

    Llano Lionel, Carabelli Guido, Brandariz Rodrigo, Taype Danilo, Barla Jorge & Sancineto Carlos

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  1. Llano Lionel
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  2. Carabelli Guido
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  3. Brandariz Rodrigo
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  4. Taype Danilo
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  5. Barla Jorge
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  6. Sancineto Carlos
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Correspondence to Llano Lionel.

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Lionel, L., Guido, C., Rodrigo, B. et al. Salvage procedure for cut-through after surgical fixation of trochanteric fractures with TFN. Eur J Orthop Surg Traumatol 32, 611–618 (2022). https://doi.org/10.1007/s00590-021-03021-0

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