• Jan Bartonícek, Vladimír Fric, Jirí Skála-Rosenbaum, and Pavel Dousa.
• Orthopaedic Department, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic. bartonic@fnkv.cz
• J Orthop Trauma. 2007 Apr 1;21(4):229-36.

ObjectiveTo evaluate patients with pertrochanteric fractures (Type 31A1 + 2 ASIF/OTA classification) treated surgically and who subsequently developed avascular necrosis of the femoral head (ANFH).SettingUniversity hospital.DesignRetrospective clinical study and analysis of the literature.PatientsFrom 1995 to 2003 the authors operated on 1,373 patients with pertrochanteric fractures. Eight patients with a mean age of 69 years (range, 52-78 years) subsequently developed ANFH.InterventionFive patients were treated with a dynamic hip screw (DHS), and 3 were treated with an intramedullary hip nail (IMHN).ResultsAll fractures in these 8 patients healed without complications in 3 to 4 months. Avascular necrosis of the femoral head developed 4 months to 4 years after the operation. Detailed analysis of these cases did not reveal any risk factors or errors in surgical technique to account for the ANFH. Results of a literature review of 41 cases in addition to our 8 cases give us reason to believe the etiology of postoperative AFNH following surgical treatment of pertrochanteric fractures is probable injury to the deep branch of the medial circumflex artery at time of fracture. Other possible risk factors include high-energy trauma, comminution, displacement of the fragments, and atypical fracture line.ConclusionsANFH develops in approximately 0.5-1% of all pertrochanteric fractures, mostly within 4 years after the injury and predominantly in patients older than 50 years of age. The diagnosis should be considered in patients who have undergone an operation previously and have symptoms that are unclear. Prevention of ANFH in these fractures includes an early reduction, stable fixation, and correct surgical technique.

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