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Table 1 Technical challenges and strategies

From: Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art

Challenge Strategy Reference
Surgical exposure Trochanteric sliding osteotomy [19, 38]
Removal of previous fixation devices Dislocating the hip joint before removing; excising the femoral head with the lag screw in situ [6, 41]
Removal of broken screws Trephines, grasping tools, a standard broken screw removal set and a metal-cutting high-speed burr [37, 40]
Revision internal fixation Avoiding a varus malreduction and obtaining stable fixation (compression technique and bone grafting) [2, 19, 42]
Bone deformity of proximal femur Restoring the relationship between the tip of greater trochanter and the center of femoral head rotation [19]
Femoral canal preparation for revision arthroplasty Endosteal sclerotic bone removal: gauge osteotome and/or a burr; refereing horizontal axis of the knee joint to adjust the anteversion of the stem; using C-arm image intensifier or fluoroscopic image intensifier to guide the placement of the stem [6, 10, 30]
Bone defect of proximal femur Calcar-replacing and long-stem implant combined with or without a prophylactic cable; tumor-type endoprosthesis [17, 39, 44, 46]
Leakage of cement through screw holes Finger pressure, packed gauze, re-inserted screws, surgical glove inflated with saline, fashioned bone plug [47, 48]
Acetabula preparation in patients with poor bone quality Reaming acetabular cartilage judiciously; avoiding forceful component impaction; considering screws augmentation [17, 37]
Greater trochanter reattachment Contoured plating, tension band wiring and trochanter claw plate with wiring [11, 30, 35, 36, 46]