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Table 4 Details of all reoperations (n = 20) and analysis of mechanisms of technical complications in treatment protocol: intramedullary nail / 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
SH2A IMN No fracture impaction IMN was load-bearing with unloading of fracture site Locking screw removed No; adjustment 4 Acceptable Good Fracture healing
JM5 DHS Intraoperative error -TH wing in hip joint Avoidable TH replaced Minor 3 Acceptable Posterior Fracture healing
JM3 DHS TH penetration –anteriorisation DHS allowed anteromedialisation due to lack of lateral/posterior support TH replaced Minor 4 Acceptable Posterior Fracture healingc
JM5 TH penetration – medialisation DHS/TH replaced with new DHS Intermediate 4 Good Good Fracture healing
SH2C Medialisation DHS replaced with IMN 4 Acceptable
JM3 Nonunion – anteromedialisation Girdlestone Major 4 Good Girdlestone
JM5 3
JM3 DHS Varus dislocation and nonunion Fracture impaction occured - DHS load-sharing was insufficient with unloading of fracture site Hip joint replacement Major 4 Good Good Hip joint replacement
JM5 Varus dislocation and cut-out 2
JM4 IMN Varus dislocation and cut-out Fracture impaction occured -IMN was loadbearing with unloading of fracture site Hip joint replacement Major 4 Acceptable Posterior Hip joint replacement
SH5 3 Good
SH2C IMN Nonunion IMN was load-bearing with unloading of fracture site IMN replaced with long DHS Intermediate 4 Acceptable Good Fracture healing
JM5 Removal of IMN and lag screw Major 4 Good Posterior Nonunion
JM5 Hip joint replacement Major 4 Good Hip joint replacement
SH3A 4
SH3A 4 Poor Proximal
SH3A IMN Broken locking screw IMN was load-bearing with unloading of fracture site and with stress concentration IMN locking screw removed Minor 4 Good Good Fracture healing
JM5 Broken IMN IMN replaced with long IMN Intermediate 3
SH5 Femoral shaft stress fracture 4 Poor
SH4 Nonunion with femoral shaft stress fracture IMN replaced with long DHS 4
  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
  5. cRecurrence of Twin Hook penetration left in situ