Digastric Mobilization for Periprosthetic Femur Fractures With Fracture of the Greater Trochanter to Prevent Migration

Introduction: Periprosthetic femur fractures following total hip arthroplasty often require revision of the femoral component at the time of fracture repair. Thirty percent of cases are associated with fractures of the greater trochanter, and this can complicate both the fracture repair and revision arthroplasty. Because stable fixation of the greater trochanter is difficult to achieve with the presence of a femoral component, postoperative migration of the greater trochanter is frequently encountered. Materials and Methods: This technique article describes an alternative surgical approach for exposure and application of a trochanteric plate via a digastric “osteotomy,” preserving the vastus lateralis origin and gluteus medius and minimus insertions without any partial tenotomy. Results: The described technique preserving attachments and insertions of gluteus and vastus lateralis minimizes the potential for displacement and migration of the greater trochanter following reduction and fixation, with good outcomes at 8 months after surgery. Discussion: Digastric mobilization of the greater trochanter provides surgeons with an alternative surgical exposure that preserves the opposing muscle forces of the abductors and vastus lateralis in a digastric fashion, thus minimizing the potential for displacement and migration in the postoperative period following reduction and fixation.