[Analysis of the failure reason of internal fixation in peritrochanteric fractures].
OBJECTIVE
To analyze the reasons and precautions for the failure of internal fixation in peritrochanteric fractures.


METHODS
A retrospective study of  256 patients treated in surgical way during the period of May 2005 to June 2009 in our hospital was utilized by Logistic regression via analyzing age, sex,  type of fracture, bone quality, type of internal fixation device, neck-shaft angle, Garden index and the initial load time.


RESULTS
The ages of 256 patients  ranged from 14 to 103 years. All the patients were treated by internal fixation, of whom 194 were followed up after surgery. The follow-up rate was 75.8%  and follow-up time 12-53 months, with an average of 17.8 months. Ten cases failed after surgery because of penetration, cut and break-up of screw and  bone non-union. The failure rate was 5.15%. The failure cases were 31-A2.2 (4 cases, 1.56%), 31-A2.3 (5 cases, 1.95%), and 31-A3.1 (1 cases, 0.39%).  The type of failure devices: Dynamic hip screw (DHS) 3 cases, proximal femoral nail (PFN) 2 cases, proximal femoral nail anti-rotation (PFNA) 1 case,  less invasive stabilization system (LISS) 4 cases. According to statistic results, initial load time after operation was a risk factor of internal fixation failure.  Generally, the older, the more osteoporosis and the less effect of internal fixation. According to our experience, the more complex fracture, the more time  before operation, the more difficult the reduction and the higher the rate of device failure.


CONCLUSIONS
The initial load time after operation is crucial to the  destiny of internal fixation. We should keep patients from early loading after operation and make a time table for the individual according to the patient's  own condition.
Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China.
Huan
H
Yang
Fang
F
Zhou
Yun
Y
Tian
Hong-quan
HQ
Ji
Zhi-shan
ZS
Zhang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D012189:Retrospective Studies; D017211:Treatment Failure; D016474:Weight-Bearing; D055815:Young Adult