HIP FRACTURE UPDATE: INTERTROCHANTERIC FRACTURE WITH FEMORAL NECK EXTENSION

Abstract

A new and very unstable intertrochanteric fracture complex is described. The intertrochanteric fracture with extension into the femoral neck is rare but results in an extremely high failure rate because of its instability. A ten-year retrospectic analysis of patients (246) with intertrochanteric fractures treated with a sliding compression hip screw at Hennepin County Medical center was performed. Of these 246 fractures, 20 were classified as fractures with a major intertrochanteric component with extension into the femoral neck. These fractures were similar to intertrochanteric fractures type I-IV described by Kyle and Gustilo in demographics, osteoporosis, and surgical treatment, but this new fracture fracture now described as Type V had a statistically higher rate of mechanical complications 0.0001, reoperation 0.0002, and failure of fixation 0.0001. The overall failure rate was 50%. The majority of these fractures were the result of complete collapse of the hip screw. We feel this higher complication and reoperation rate is secondary to inherent instability in the intertrochanteric fracture which extends into the femoral neck. This instability leads to cmplete collapse of a sliding hip screw result ing in a rigid device that leads to failure of fixation. This fracture complex also has a higher rate of nonunion and avascular necrosis. Although rare, this fracture must be recognized in the fracture classification of intertrochanteric fractures because of its poor prognosis. Other forms of treatment than a sliding hip screw may be considered with this fracture complex because of its high failure rate with standard treatment.