Top

European Journal of Trauma and Emergency Surgery

Published in:

01-06-2014 | Review Article

Primary prosthetic replacement in per- and intertrochanteric fractures

Authors: M. Hoffmann, M. Hartel, J. M. Rueger, W. Lehmann

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2014

Abstract

Purpose

Hip arthroplasty is rarely indicated in the treatment of per- and intertrochanteric femur fractures. Although the majority of fractures are amenable to closed- or open reduction and internal fixation (CRIF/ORIF), in some patients the complexity of the fracture or other patient-related factors may cause the orthopaedic surgeon to consider arthroplasty as the treatment of choice. Decision-making is challenging, and a reliable score has not yet been established.

Results

Reviewing literature, several predictors of inferior outcome after CRIF/ORIF in per- and intertrochanteric fractures such as age, gender, poor bone quality, hip osteoarthritis, operation time and postoperative weight-bearing restrictions have been identified. Based on the literature review, a novel Hamburg Per- and Intertrochanteric Fracture Score (HPIFS) is proposed to support decision-making for per- and intertrochanteric fracture treatment.

Conclusions

CRIF/ORIF remain the workhorses in per- and intertrochanteric fracture management. Arthroplasty offers an advantageous treatment option for a well-defined patient and fracture collective. The HPIFS might support the decision-making process.

Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty. 2005;20(3):337–43.PubMedCrossRef

Zuckerman JD. Hip fractures. N Engl J Med. 1996;334:1519.PubMedCrossRef

Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000;371:206.PubMedCrossRef

Kyle RF, Gustillo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone J Surg. 1979;61-A:216.

Mariani EM, Rand JA. Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation. Clin Orthop Relat Res. 1987;218:81.PubMed

Lu-Yao G, Keller R, Littenberg B. Outcomes after displaced fractures of the femoral neck. A metaanalysis of 106 published reports. J Bone J Surg. 1994;76A:15.

Hardy DCR, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures: a prospective, randomized study of one hundred patients. J Bone Joint Surg. 1998;80:618.PubMed

Haentjens P, et al. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. J Bone Jonit Surg. 1989;71-A:1214.

Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop. 2006;30:69–78.PubMedCentralPubMedCrossRef

10.

Nuber S, Schonweiss T, Ruter A. Stabilisation of unstable trochanteric femoral fractures. Dynamic hip screw (DHS) with trochanteric stabilisation plate vs. proximal femur nail (PFN). Unfallchirurg. 2003;106:39–47.PubMedCrossRef

11.

Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, HoVmeyer P. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma. 2002;16:386–93.PubMedCrossRef

12.

Utrilla AL, Reig JS, Munoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma. 2005;19:229–33.PubMedCrossRef

13.

Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg. 2007;127(10):959–66.PubMedCentralPubMedCrossRef

14.

Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures: a prospective, randomized study. J Bone Joint Surg Am. 2005;87(10):2186–92.PubMedCrossRef

15.

Calvert PT. The gamma nail: a significant advance or passing fancy? J Bone Joint Surg. 1992;74-B:329.

16.

Bridle SH, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur: a randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg. 1991;73-B:330.

17.

Broos PL, Willemsen PJ, Rommens PM, Stappaerts KH, Gruwez JA. Pertrochanteric fractures in elderly patients: treatment with a long-stem/long-neck endoprosthesis. Unfallchirurg. 1989;92:234–9.PubMed

18.

Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop. 2002;26:233–7.PubMedCentralPubMedCrossRef

19.

Geiger F, Schreiner K, Schneider S, Pauschert R, Thomsen M. Proximal fracture of the femur in elderly patients: the influence of surgical care and patient characteristics on post-operative mortality. Orthopade. 2006;35(6):651–7.PubMedCrossRef

20.

Andress HJ, Kahl S, Kranz C, Gierer P, Schürmann M, Lob G. Clinical and finite element analysis of a modular femoral prosthesis consisting of a head and stem component in the treatment of pertrochanteric fractures. J Orthop Trauma. 2000;14(8):546–53.PubMedCrossRef

21.

Dobbs RE, Parvizi J, Lewallen DG. Perioperative morbidity and 30-day mortality after intertrochanteric hip fractures treated by internal fixation or arthroplasty. J Arthroplasty. 2005;20(8):963–6.PubMedCrossRef

22.

Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM. Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplasty. 2005;20(4):414–20.PubMedCrossRef

23.

Steinberg B, Harris WH. The doffsetT problem in total hip arthroplasty. Contemp Orthop. 1992;24:556.

24.

Mabry TM, Prpa B, Haidukewych GJ, Harmsen WS, Berry DJ. Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg Am. 2004;86-A:2263–7.PubMed

Title: Primary prosthetic replacement in per- and intertrochanteric fractures
Authors: M. Hoffmann
M. Hartel
J. M. Rueger
W. Lehmann
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2014
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-014-0412-9

At a glance: The STEP trials

Springer Medicine

Primary prosthetic replacement in per- and intertrochanteric fractures

Abstract

Purpose

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2014

Massive haemorrhage following minimally displaced pubic ramus fractures

The exponential function transforms the Abbreviated Injury Scale, which both improves accuracy and simplifies scoring

Lower extremity fractures in falls

Vascular injuries following blunt polytrauma

Should prehospital resuscitative thoracotomy be incorporated in advanced life support after traumatic cardiac arrest?

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?