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Table 3 Details of all reoperations (n = 20) and analysis of mechanisms of technical complications in treatment protocol: Medoff sliding plate/dynamic hip screw

From: Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures – postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate

Fracture type Fixation Analysis of mechanism Reflection on mechanism of complication Reoperation Technical complication category Surgeon’s experiencea Fracture reduction Twin hook/lag screw position Outcomeb
JM5 MSP uniaxial Sliding plate consumed In line with treatment protocol Locking screw removed No; adjustment 2 Acceptable Good Fracture healing
SH2C 3
SH3A 4 Good
SH5 1
SH5 2 Acceptable
SH5 3
SH5 2 Poor
JM5 MSP biaxial Intraoperative error -TH wing in hip joint Avoidable TH replaced Minor 3 Poor To distal Fracture healing
JM5 MSP uniaxial TH penetration – sliding plate consumed, but locking screw not removed Locking screw should have been removed postoperatively, since plate sliding capacity was consumed TH replaced locking screw removed Minor 2 Poor Good Fracture healing
JM5 4 Good
SH2C 2
SH5 3
SH3A 3 Acceptable
SH3A 4
JM3 DHS Medialisation and varus dislocation DHS allowed anteromedialisation due to lack of lateral/posterior support Hip joint replacement Major 1 Good Good Hip joint replacement
JM5 MSP biaxial TH penetration –medialisation MSP should have been locked. Biaxial MSP allowed anteromedialisation due to lack of lateral/posterior support MSP biaxial replaced with MSP uniaxial Intermediate 3 Acceptable Good Fracture healing
JM5 Medialisation and varus dislocation Hip joint replacement Major 4 Good Hip joint replacement
JM2 DHS Varus dislocation and cut-out Fracture impaction occured - DHS load-sharing was insufficient with unloading of fracture site Hip joint replacement Major 2 Good Posterior Hip joint replacement
SH5 IMN Nonunion with broken IMN IMN was load-bearing with unloading of fracture site and with stress concentration IMN replaced with uniaxial MSP Intermediate 4 Acceptable Good Fracture healing
  1. JM Jensen Michaelsen fracture classification, SH Seinsheimer fracture classification
  2. TH Twin hook, DHS dynamic hip screw, MSP Medoff sliding plate, IMN intramedullary nail
  3. aDocumented number of previous trochanteric hip fracture surgeries performed by index operation surgeon: Less than 101, 10 to 242, 25 or more3, or specialist orthopaedic surgeon4
  4. bFracture considered as healing if no documentation of diversion from fracture healing at final follow-up