Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Background: Femoral cervicotrochanteric fracture fixation failure often requires a salvage procedure to preserve the hip. To understand its limitations, this study investigated the use of intertrochanteric osteotomy for this purpose and analyzed causes of failure. Methods: During 2001 − 2017, 21 patients (males:females = 12:9; 47 ± 17 years) with failed femur cervicotrochanteric fracture fixation were treated with intertrochanteric osteotomy. All patients were followed-up using functional assessment according to the Harris hip score (HHS) and radiological assessment. The clinical end-point was conversion to hip arthroplasty for any reason or acquiring a symptomatic hip with a HHS < 80. Results: With a follow-up duration of 124 ± 63 months, success was achieved in 16 patients, whereas 5 patients developed fixation failure. Early failure was associated with fixation loss in 2 hips with subcapital fractures, while late failure was related to progression of pre-existing osteonecrosis of the femoral head (ONFH) in 3 hips. Aside from the 2 early failure hips, the osteotomy healed uneventfully in all cases, and the original fracture sites healed within 17.2 ± 6.3 weeks. Of the 5 hips converted to arthroplasty, standard femoral implants were used without the need to re-perform an osteotomy to align the medullary canal. At the final follow-up, significant improvements in limb-length discrepancy (LLD), neck-shaft angle (NSA), and HHS were observed. The valgus osteotomy angle for correction was 21.9° ± 8.4°, and this was maintained at 21.1° ± 10.5° during follow-up. Conclusions: Intertrochanteric osteotomy is a useful operation and can promote fracture-healing in cases of failed cervicotrochanteric fracture fixation. Subcapital fracture with limited bone to enable secure purchase of the fixation device and pre-existing ONFH were associated with high failure rates. In such cases, salvage should not be attempted using this procedure alone, and arthroplasty or other salvage procedures may be necessary.