title: Avascular necrosis and related complications following healed osteoporotic intertrochanteric fractures.
abstract: BACKGROUND
  Femoral hip fractures are a common occurrence in the elderly. Of the various fracture patterns, intertrochanteric injuries have the lowest rate of complications. Case reports of ensuing subcapital fracture have all been linked to incorrect placement of fixation devices or to osteomyelitis, white cases of avascular necrosis have only been reported rarely in the literature and are considered to occur at the rare rate of 0.8%.
  
  
  OBJECTIVE
  To check the incidence and outcome of AVN in intertrochanteric hip fractures.
  
  
  RESULTS
  In a retrospective analysis of patients who had surgical treatment for intertrochanteric fractures. 10 patients (0.5%) underwent dynamic hip screw fixation for intertrochanteric fractures and subsequently developed painful AVN as their primary presentation. Three of these patients were also found to have subcapital fractures. On revision of the primary fixation no fault was found with nail placement.
  
  
  CONCLUSIONS
  The reported rate of AVN may be understated since many patients have limiting factors that prevent them from consulting a physician when in pain, and one-third of these patients die within 2 years. Therefore, we suggest that hip pain following fixation of an intertrochanteric fracture should prompt the clinician to consider the rare possibility of AVN or subcapital fracture.
authors.affiliation: Department of Orthopedic Surgery, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mattan
authors.forename: Alice
authors.initials: A
authors.lastname: Dimant
authors.forename: Rami
authors.initials: R
authors.lastname: Mosheiff
authors.forename: Amos
authors.initials: A
authors.lastname: Peyser
authors.forename: Steven
authors.initials: S
authors.lastname: Mendelson
authors.forename: Meir
authors.initials: M
authors.lastname: Liebergall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005593:Fracture Fixation, Internal / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies