Avascular necrosis and related complications following healed osteoporotic intertrochanteric fractures.
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.
Mattan
Yoav
Y
Department of Orthopedic Surgery, Hadassah University Hospital, Jerusalem, Israel.
Dimant
Alice
A
Mosheiff
Rami
R
Peyser
Amos
A
Mendelson
Steven
S
Liebergall
Meir
M
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