Challenge of the Week / Trauma / 01.03.20

A 65-year-old female patient presents with persistent right groin pain 6 months after open reduction and internal fixation of a right pertrochanteric femur fracture. Imaging shows a cephalomedullary nail fixation with instability. She has no history of delayed wound healing. Evaluation for an infection is negative. Which of the following is the best option for revision for this patient?
  • Revision cephalomedullary nail
  • A revision cephalomedullary nail fixation could potentially result in appropriate alignment, but the loss of alignment makes cephalomedullary nail revision technically challenging.

  • Locking proximal femoral plate
  • Locking proximal femoral plates are associated with significant failure rates and should be used only when other implant options are not viable.

  • Sliding hip screw
  • Sliding hip screw may provide a fixed-angle construct, but is unable to provide compression or precise control of many pertrochanteric femur fractures.

  • Angled blade plate
  • Angled blade plates provide the best balance between stable fixation and the ability to create the appropriate conditions for fracture healing.

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