Total Hip Replacement after a Failed Trochanteric Fracture Fixation: A Case Report

Intertrochanteric fractures are common in the elderly, with high mortality (15%–20% annually). Internal fixation is the standard treatment, but failures may require revision with total hip arthroplasty (THA), where the stem choice is controversial due to challenges like scar adhesion and implant stabilityA 58-year-old woman with a right intertrochanteric fracture from a road accident initially treated with proximal femoral nailing developed nonunion and lag screw backout. After uncemented THA, she experienced dislocation and an iatrogenic periprosthetic fracture (Vancouver B2) during closed reduction. Revision THA via a posterior approach involved careful dissection due to adhesions. A shorter stem and a long distal femur anatomical plate stabilized the fracture. A recurrent dislocation was managed with open reduction and capsular closure. Postoperative care included a broomstick cast, followed by progressive mobilization. At 6 months, she ambulated independently with excellent recovery. This case illustrates the complexities of failed trochanteric fracture management, emphasizing individualized surgical approaches. Successful revision THA with a shorter stem and additional fixation offers valuable insights for similar cases.