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

Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

doi:10.1186/s12891-017-1723-x

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 experience^a	Fracture reduction	Twin hook/lag screw position	Outcome^b
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 healing^c
JM5		TH penetration – medialisation		DHS/TH replaced with new DHS	Intermediate	4	Good	Good	Fracture healing
SH2C		Medialisation		DHS replaced with IMN	Intermediate	4	Acceptable		Fracture healing
JM3		Nonunion – anteromedialisation		Girdlestone	Major	4	Good		Girdlestone
JM5		Nonunion – anteromedialisation		Girdlestone	Major	3	Good		Girdlestone
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	DHS	Varus dislocation and cut-out		Hip joint replacement	Major	2	Good	Good	Hip joint replacement
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	IMN	Varus dislocation and cut-out		Hip joint replacement	Major	3	Acceptable	Good	Hip joint replacement
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		Good
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	Good
SH5		Femoral shaft stress fracture		IMN replaced with long IMN		4	Poor
SH4		Nonunion with femoral shaft stress fracture		IMN replaced with long DHS		4	Poor

JM Jensen Michaelsen fracture classification, SH Seinsheimer fracture classification
TH Twin hook, DHS dynamic hip screw, MSP Medoff sliding plate, IMN intramedullary nail
^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
^bFracture considered as healing if no documentation of diversion from fracture healing at final follow-up
^cRecurrence of Twin Hook penetration left in situ

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ISSN: 1471-2474

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