Surgical treatment of femoral shaft fractures after total or hemiarthroplasty of the hip

Abstract We report the clinical and radiographical results of surgical treatment of 45 patients with femoral fractures after hip replacement, seen at the Orthopaedic and Trauma Center (CTO) of Florence from 1980 to 1997; fractures treated conservatively were excluded from this retrospective review. There were 30 fractures in patients with homolateral total hip prosthesis and 15 in patients with homolateral hemiarthroplasty of the hip. The mean age of the patients was greater in the second group than in the first group (79 vs. 72 years). Fractures were classified according to Duncan and Masri as types B1 (n=16), B2 (n=13), B3 (n=10) and C (n=6). They were treated surgically by open reduction and internal fixation (ORIF) using cerclage (n=9), plates and screws (n=19), or plates and cerclage (n=2), or revision procedure using long, non-cemented stems (n=13) and a two stages revision in procedure in two cases in whom fractures occurred because of deep infection. At follow-up we evaluated healing, complications, leg length discrepancies, thigh pain, and the patients subjective satisfaction. We found non-union only in 1 case (2.4%). Our results confirm the strict correlation between surgical indications and clinical results: ORIF can be safely proposed only if the stem is well fixed. In fact, all 6 unsatisfactory outcomes (14.3%) were due to technical errors during the surgical procedures: the fractures healed (ORIF was correctly performed) but the stems were unstable and continued to give pain and discomfort.