[Hip replacement after failed internal fixation in patients with proximal femur fracture--a simple procedure?]

Between January 1995 and December 2000 we operated on 1 437 patients with fractures of the proximal femur. In 789 cases an osteosynthesis was performed and in 648 cases a prosthesis was implanted. In the group of patients with primary osteosynthesis we stabilized 89 fractures with screws, in 319 patients a dynamic hip screw (DHS) and in 381 patients a Proximal-Femurnail (PFN) were implanted. Because of major complications we had to reoperate on 42 patients (5.3 %) with primary osteosynthesis. For analysis of this high complication rate we studied the fracture type, the type of complication, the operation time, the primary and secondary implant type and the time of postoperative mobilisation in this group of 42 patients. We saw 27 type A and 15 type B fractures, according to the AO classification. In the patient group with complications 4 times a primary screw stabilisation was done, 22 dynamic hipscrews (DHS) and 16 proximal femurnails (PFN) were implanted. After changing the primary osteosynthesis into 15 hemiprostheses and 26 total prostheses of the hip, we found in over 30 % major complications. A change of the procedure after primary osteosynthesis has to be regarded as a more difficult operation than the primary implantation of a prosthesis.