Date: Tue, 2 Sep 2003 09:54:02 +0200

From: Alo Kullerkann

Subject: Hemiarthroplasty + greater trochanter fx

Dear Members,

Your opinion is sought.

88 y/o active, generally well male was operated due femoral neck fracture. Austin-Moore hemiprosthesis was used through anterolateral approach. During implantation greater trochanter fracture occurred.

As greater trochanter was pretty stable and had good soft tissue envelope I decided not to additionally fix it. Postop day 3 patient is walking PWB with common wound pain.

Is it necessary to fix greater trochanter in this situation? If yes by what method - tension band, screws, transosseal sutures?

And last but not least in a healthy 88 y/o but biologically about 70 y/o and sound hip would anybody go for osteosynthesis?

Alo Kullerkann, MD.
Orthopaedic Surgeon
Mustame Hospital, Tallinn
Estonia

Reply at: Orthopaedic Trauma Association forum

Date: Tue, 2 Sep 2003 17:35:17 -0500

From: Andrew H. Schmidt

Is it necessary to fix g.troch in this situation. If yes by what method - tension band, screws, transosseal sutures?

I think that it is okay to leave the greater troch alone in this situation, but would protect the patient from active abduction for several weeks.

And last but not least in a healthy 88 y/o but biologically about 70 y/o and sound hip would anybody go for osteosynthesis?

Given your description of this patient, I think that the best operation for him would be total hip replacement. It offers the least risk of complications and the most durable function.

Andrew H. Schmidt, M.D.
Faculty, Hennepin County Medical Center
Assoc. Professor, Univ. of Minnesota
Minneapolis, MN

Date: Tue, 2 Sep 2003 22:38:08 +0530

From: rajesh

Happened to me once, last year in the UK.I used a wiring kit and wired everything together.It was a cemented thompson hemiarthroplasty and quite stable but since the fracture seperated off a big piece of trochanter,I thought it was better to overdo than risk a second surgery. she did well.

Dr. K. R. Rajesh, MS, DipNB, FRCS, FRCS(Orth)
Consultant Orthopaedic Surgeon
Lords Hospital & Cosmopolitan Hospital
Trivandrum, India.