Hemiarthroplasty in Comminuted Peritrochanteric Fracture

Grossly comminuted peritrochanteric fracture with osteoporosis and medical co-morbidities is a lethal combination. This title demonstrates a surgical technique in which the inferomedial or the calcar femoris segment of the proximal fragment is harvested and wedged between the medial femoral cortex and the medial surface of the prosthesis shaft.

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This title focuses on such areas as: trauma and hip, knee & lower extremity. In the elderly, grossly comminuted peritrochanteric fracture associated with osteoporosis and medical co-morbidities is a lethal combination. Internal fixation with DHS (dynamic hip screw) or PFN (proximal femoral nail) have success rate of up to 70 per cent but require prolonged rehabilitation. Hemiarthroplasty is a viable option, but it is technically more demanding than the procedure done for subcapital fracture. Fracture through the lesser trochanter causes loss of postero-medial bony support, which causes the prosthesis to sink deep in the medullary canal and settle into varus and retroversion, thus resulting in limb length inequality, instability, and early failure. In this video, the authors demonstrate a surgical technique in which the inferomedial or the calcar femoris segment of the proximal fragment is harvested and wedged between the medial femoral cortex and the medial surface of the prosthesis shaft.