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Conversion total hip replacement after malunited intertrochanteric fracture: a technical note.

Aasis Unnanuntana1, Stuart B Goodman

  • 1Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94035, USA. uaasis@yahoo.com

American Journal of Orthopedics (Belle Mead, N.J.)
|December 17, 2008
PubMed
Summary
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Malunited intertrochanteric fractures present unique challenges for total hip replacement due to altered anatomy. This study details surgical techniques to avoid complications like femoral fracture and canal misidentification.

Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Biomedical Engineering

Background:

  • Malunited intertrochanteric fractures cause significant anatomical alterations.
  • These changes, including femoral canal medialization and remodeling, complicate total hip replacement.
  • Standard surgical approaches may be inadequate for these complex cases.

Purpose of the Study:

  • To describe specific surgical steps and techniques for managing malunited intertrochanteric fractures.
  • To highlight methods for avoiding intraoperative complications during total hip replacement in these patients.
  • To provide guidance for surgeons encountering these challenging cases.

Main Methods:

  • Review of anatomical changes associated with malunited intertrochanteric fractures.

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  • Description of modified surgical techniques for hip dislocation and femoral canal identification.
  • Emphasis on pre-operative recognition of anatomical variations.

    • Main Results:

    • Identification of key anatomical challenges: medialized canal, remodeling, sclerosis.
    • Specific techniques to prevent spiral femoral fracture during dislocation.
    • Strategies to ensure accurate femoral canal identification.
    • Minimization of potential intraoperative complications.

    Conclusions:

    • Pre-operative recognition of anatomical changes is critical for successful surgery.
    • Specific surgical techniques can effectively manage the complexities of malunited intertrochanteric fractures.
    • Adherence to described methods can minimize intraoperative risks and improve patient outcomes.