Key result
Salvage strategies for failed femoral fracture fixation, tailored to fracture location and patient age, generally yield good outcomes despite technical challenges.
Salvage strategies for failed femoral fracture fixation depend on patient age and fracture location, with joint preservation favored in young patients and hip replacement in older patients.
May guide age- and location-specific salvage decisions in failed femoral fixation; leaves open need for prospective comparative trials.
Most hip fractures treated with modern internal fixation techniques will heal. However, failures occasionally occur and require revision procedures. Salvage strategies employed during revision are based on whether the fixation failure occurs in the femoral neck, or in the intertrochanteric region. Patient age and remaining bone stock also influence decision making. For fractures in young patients, efforts are generally focused on preserving the native femoral head via osteotomies and repeat internal fixation. For failures in older patients, some kind of hip replacement is usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers from previous internal fixation devices all pose technical challenges to successful reconstruction. Attention to detail is important in order to minimise complications. In the majority of cases, good outcomes have been reported for the various salvage strategies.
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Petrie et al. (2013) conducted a review in Femoral fracture fixation failure. Salvage strategies (osteotomies, repeat internal fixation, hip replacement) was evaluated. Salvage strategies for failed femoral fracture fixation, tailored to fracture location and patient age, generally yield good outcomes despite technical challenges.
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