Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric
fractures were included in this study. The mean age of the patients was 61
years (range, 38—84 years). Average limb shortening was 2.4 cm; 18 patients were
treated with revision internal fixation and eight patients with prosthetic replacement.
The decision depended on the physiological age of the patient, quality of bone,
and condition of the femoral head and the acetabulum. The revision internal fixation
group included DHS reinsertion in eight patients, valgus osteotomy and revision DHS
fixation in six, while four patients were treated by valgus osteotomy and insertion of
single-angled 1308 plate. The prosthetic replacement group included cemented
Thompson endoprothesis in five patients and cemented total hip arthroplasty in
three. The mean follow-up period was 31 months (range, 15—72 months). All patients
of revision internal fixation group achieved fracture healing without bone grafting.
Time to union averaged 17 weeks. Average gain in length was 2 cm Avascular necrosis
of the femoral head occurred in one patient. Six patients of the prosthetic replacement
group achieved good functional outcome and pain-free gait. The remaining two
had unsatisfactory result.