Abstract:

BACKGROUND: Many internal fixations, such as dynamic hip screw, Gamma screw, proximal femoral nail, angle steel plate, as well as locking proximac femoral plate, are utilized in treating intertrochanteric fractures, especially the dynamic hip screw. However, the failure rate is gradually increased.
OBJECTIVE: To explore the application and clinical efficacy of total hip replacement for the treatment of elderly intertrochanteric fracture fixation after failure of dynamic hip screw.
METHODS: A total of four cases with intertrochanteric fractures were treated by total hip replacement after failure of dynamic hip screw fixation was selected. According to Evans typing, one case were type Ⅱ, two cases were type Ⅲ A, and one case was type ⅢB. Internal fixation displacement could be found at half to 1 year after dynamic hip screw fixation. Because of bone disunion, coxa adducta and pain, the patients could not walk. Sequentially, total hip replacement was performed with 45° abduct angle and 10°-15° anteversion angle. The clinical efficacy was evaluated by Harris scoring criteria.
RESULTS AND CONCLUSION: All the cases were operated smoothly, with 1.5-2 hour operation duration and 400-600 mL blood loss. No case appeared allergic response to bone cement. By 3-12 months follow-up, 4 successful operative cases do not appear prosthesis loosening, subsidence and are satisfied with well hip function. The average Harris score were 81 points. The results revealed that application of total hip replacement after the failure of DHS in elderly intertrochanteric fracture fixation, which  shortened the time patients stay in bed to reduce complications and improved the hip joint function.