{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:53:52Z","timestamp":1791219232334,"version":"4.1.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u00b1 16.02 years. Of these, 96 were intertrochanteric fractures classified by the Arbeitsgemeinschaft f\u00fcr 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The average follow-up time was 15.96 \u00b1 5.61 months. The joint replacement group had a significantly higher mean age (72.13 \u00b1 13.00 years) than the revision internal fixation group (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). The average revision surgery duration was 143.06 \u00b1 57.29 min, with the joint replacement group having significantly shorter operation times (107.50 \u00b1 41.40 min,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01), which were comparable to those of the type I revision group. Intraoperative blood loss averaged 344.26 \u00b1 335.43 ml, with the type I and joint replacement revision group showing the least blood loss (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). The mean healing duration was 7.08 \u00b1 3.33 months. Harris hip scores improved from 24.78 \u00b1 6.08 pre-operatively to 80.59 \u00b1 4.54 post-operatively. Patients who underwent type IV revisions had significantly lower scores (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1773816","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:58:23Z","timestamp":1772607503000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes and revision strategies following failed internal fixation of peri-trochanteric femoral fractures: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yujie","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]},{"name":"Orthopedics Research Institute of Zhejiang University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province","place":["Hangzhou, Zhejiang, China"]},{"name":"State Key Laboratory of Transvascular Implantation Devices","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaorong","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]},{"name":"Clinical Research Center of Motor System Disease of Zhejiang Province","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanxiao","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]},{"name":"Orthopedics Research Institute of Zhejiang University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erman","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]},{"name":"Orthopedics Research Institute of Zhejiang University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]},{"name":"Orthopedics Research Institute of Zhejiang University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]},{"name":"Orthopedics Research Institute of Zhejiang University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e092092","DOI":"10.1136\/bmjopen-2024-092092","article-title":"Effect of oral trehalose supplementation on inflammation and wound healing in patients with peri-trochanteric fractures: study protocol for a randomised clinical trial","volume":"14","author":"Zandi","year":"2024","journal-title":"BMJ 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