ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Clinical Outcomes and Revision Strategies Following Failed Internal Fixation of Peri-trochanteric Femoral Fractures: A Retrospective Cohort Study
Yujie Zhang
Fan Yang
Chaorong Yu
Hanxiao Zhu
Erman Chen
Hang Li
Weixu Li
Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
Background: Revision surgery for femoral peri-trochanteric fractures is a complex and high-risk intervention. This study aimed to systematically examine the multifaceted etiologies of primary internal fixation failures, classify them into distinct categories, and develop tailored revision strategies to enhance overall management and optimize clinical outcomes in peri-trochanteric fracture cases. Methods: We conducted a retrospective study of 141 peri-trochanteric fractures with failed internal fixation surgery between 2013 and 2023. The cohort comprised 87 males and 54 females, with a mean age of 60.34 ± 16.02 years. Of these, 96 were intertrochanteric fractures classified by the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) system (28 type A1, 20 type A2, and 48 type A3), and 45 were subtrochanteric fractures classified by the Seinheimer system. We conducted an in-depth analysis of failure mechanisms and subsequently categorized the patients into four groups, each with distinct revision procedures. Results: The average follow-up time was 15.96 ± 5.61 months. The joint replacement group had a significantly higher mean age (72.13 ± 13.00 years) than the revision internal fixation group (P < 0.05). The average revision surgery duration was 143.06 ± 57.29 min, with the joint replacement group having significantly shorter operation times (107.50 ± 41.40 min, P < 0.01), which were comparable to those of the type I revision group. Intraoperative blood loss averaged 344.26 ± 335.43 mL, with the type I and joint replacement revision group showing the least blood loss (P < 0.01). The mean healing duration was 7.08 ± 3.33 months. Harris hip scores improved from 24.78 ± 6.08 preoperatively to 80.59 ± 4.54 postoperatively. Patients who underwent type IV revisions had significantly lower scores (P < 0.05). Conclusions: We classified peri-trochanteric fracture surgical failures into four distinct categories based on age, presence of infection, integrity of the femoral head and acetabulum, varus deformity, and implant condition. We developed detailed diagnostic and treatment protocols for each category. Adhering to our established protocols, the imaging results and functional scores of all patients were consistently favorable. Our comprehensive treatment strategy can serve as a critical reference for standard revision procedures in the management of peri-trochanteric fractures.
Summary
Keywords
clinical outcome, Femoral peri-trochanteric fractures, Hip Fractures, Internal fixation failure, Revision surgery
Received
23 December 2025
Accepted
11 February 2026
Copyright
© 2026 Zhang, Yang, Yu, Zhu, Chen, Li and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Weixu Li
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