Intertrochanteric Fracture of the Femur

Description

Professor Dominic Meek gives his expert insights in this segment which revolves around the treatment options for a 78-year-old patient who previously suffered a pair trochanteric fracture of the femur, treated with a dynamic hip screw. This patient is now experiencing secondary osteoarthritis in the hip joint and is presumed fit for a total hip replacement due to their symptomatic condition. Various surgical approaches are evaluated, including removal of the dynamic hip screw and consideration of hip resurfacing. It is deemed inadvisable due to the risks associated with the patient's age and bone density.



The alternative suggestion includes using a strut allograft with a cable plate alongside a cemented stem to reinforce the femur. However, this approach may be excessive, as the cement itself can address defects from screw removal without the need for allografts. Professor Meek advises against adding any extra external load-sharing devices, as they may cause further complications, including stress shielding and potential periprosthetic fractures.



For best outcomes in this elderly patient, the recommendation leans towards utilizing a cemented stem that can bypass screw holes by achieving sufficient cortical thickness, thereby eliminating the need for any additional augmentation. This technique emerges as both practical and reliable for managing the patient's hip replacement surgery.


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DOI: 10.1302/3114-251262

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