Intraoperative hip fractures: ruining your day

The results of treatment of 116 intraoperative femoral fractures were reviewed. Excluding calcar and greater trochanter fractures, there were 14 Type I cases (Vancouver classification). All healed with cerclage wiring. Three cases of vertical fractures of the proximal segment following a subtrochanteric osteotomy did not heal and required revision. There were 8 Type II fractures, most being minor splits or limited, nondisplaced, vertical fractures. Control was lost in 2 wired cases, suggesting that Type II fractures should be converted to Type I by the use of a long stem, or, if impractical, by supplementary fixation. In 7 septic cases, a comminuted fracture occurred during implant removal. An intramedullary nail and cerclage wires were used, and the patients were left with a Girdlestone. The infections were overcome, the fractures healed, and subsequent revision was straightforward, because an open channel existed in the femur.