Treatment of Pathologic Peritrochanteric Fractures Using Sliding Hip Screws Augmented with Cerclage Reconstruction Plates

Abstract

We proposed a new method to augment the traditional sliding hip screw (SHS) with cerclage reconstruction plates to treat pathologically impending and actual peritrochanteric fractures as well as to revise open reductions and internal fixations to increase the construct strength against the shearing force, thus reducing the implant failure rate. In this retrospective study, patients with peritrochanteric pathology with at least two years of follow-up who underwent augmentation with cerclage reconstruction plates (modified SHS) and conventional SHS between 1 May 2015 and 31 May 2017 were divided into groups A (n = 12) and B (n = 28), respectively. Demographic data, surgery duration, blood loss, complications, and local radiotherapy were analyzed. The average surgery duration was significantly longer in group A (p = 0.013). The estimated intraoperative and perioperative blood losses were not significantly different between the groups. The implant survival rates were not significantly different under competing risk analysis. The success rate of a revision surgery with modified SHS was excellent, and implant survival time was >2 years, as observed with the previous SHS constructs. Subtrochanteric region involvement and a postoperative visual analog scale ≥4 could be risk factors of implant failure and revision surgery. This technique can be an alternative treatment for difficult pathologic peritrochanteric fractures, especially those with previous plating failure.

Keywords: augmentation; cerclage reconstruction plate; impending; metastasis; pathologic fracture; peritrochanteric; sliding hip screw.

Figure 1

A difficult case with multiple implant failures: (a) preoperative X-ray image, (b) first-time implant failure, (c) second-time implant failure, (d) third-time implant failure, and (e) fourth-time implant failure.

Figure 2

Flowchart of the study.

Figure 3

Surgical procedure of modified SHS: (a) a 3.5 mm AO reconstruction plate was chosen after consideration of the curve and length; (b) intraoperative photograph of the cerclage reconstruction plate.

Figure 4

An implant failure case in group B: (a) original postoperative X-ray image, (b) first implant failure, and (c) postoperative plain radiograph after revision surgery with modified SHS.

Figure 5

Competing risk regression. Analysis time (year).

Figure 6

Illustration of the change in shearing force: (a) the shearing force increased due to PMMA cement augmentation, (b) loading failure with distal cortical screw fracture with SHS fixation only, and (c) the modified SHS technique increases the strength to resist the shearing force.