Abstract
Introduction Proximal femoral fractures (PFF) in the elderly have high complication rates contributing to associated morbidity and mortality. This study aimed to identify any specific patterns or factors contributing to surgical failures requiring re-operation in these patients.
Methods A retrospective review of 441 PFF treated operatively during a consecutive 27 month period was performed. Relevant data was obtained from operation records, medical records and x-ray reviews. The re-operation rate was calculated according to the fixation method (e.g. DHS) as well as fracture type (e.g. intertrochanteric).
Results Of the PFF treated operatively 40 required subsequent procedure(s). There were 28 mechanical failures and 12 deep infections. Of the mechanical failures four required more than one subsequent operation and five patients died within six months of revision surgery. Technical error was a significant factor in six of the 28. Repeat falls during the post-operative rehabilitation phase accounted for the majority of periprosthetic fractures. Of the deep infections five required removal of hardware and seven underwent incision and drainage. Dynamic condylar screw fixation for the subtrochanteric fractures had higher mechanical failure (50%) compared to intramedullary nail fixation (13%).
Conclusions Technical error, improper implant selection and falls during post-operative rehabilitation period are significant factors contributing to failures in PFF fixation and should be avoided.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
