Journal of Musculoskeletal Trauma

Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis: Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang; J Korean Fract Soc 2024;37(3):144-149. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.144

Abstract PDF: Purpose
The incidence of hip fractures is increasing due to an increase in elderly populations because elderly patients often have accompanying diseases, such as cognitive impairment or dementia, which may lead to missed fractures. Therefore, this study assessed the utility of bone scans in detecting missed fractures in elderly patients.
Materials and Methods
This study analyzed the data from 178 patients treated from January 2014 to March 2023. The inclusion criteria were patients who had hip fractures with osteoporosis over 70 years old. Bone scans were performed on average 10 days after injury. The rate and trend of missed fractures not detected in the initial diagnosis were determined based on sex, age, dementia status, and the presence of osteoporosis.
Results
Among the 178 hip fracture patients over 70 years old, 37 patients had a history of being diagnosed with dementia, and 141 patients had never been diagnosed. Missed fractures were confirmed in 49 cases (42 patients) (23.6%). The dementia group had 13 missed fractures, and the non-dementia group had 36 missed fractures, but there was no significant difference. Rib fractures were most common, followed by vertebral fractures.
Conclusion
Missed diagnoses of fractures were common among elderly hip fracture patients. A whole body bone scan appeared to be effective in detecting missed fractures. Therefore, identifying accompanying fractures through bone scans and delivering appropriate treatment can play an important role in postoperative rehabilitation.

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Effect of Coincident Hip Fracture on Distal Radius Fracture in Patients Treated with a Volar Locking Plate: A Matched-Pair Analysis of Elderly Patients: Hyoung-Seok Jung, Min-Su Chu, Jae-Sung Lee; J Korean Fract Soc 2024;37(3):137-143. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.137

Abstract PDF: Purpose
Although the incidence of simultaneous distal radius and hip fractures in older patients is minimal, patients with these coincident types of fractures exhibit unique features. This study analyzed the outcomes associated with operative treatment involving volar-locking plates in patients who sustained distal radius fractures and hip fractures and compared them with those in matched control patients who had undergone treatment for isolated distal radius fractures.
Materials and Methods
Between 2010 and 2015, 34 patients, who met the criteria for hip and distal radius fractures, were retrospectively reviewed. Thirty-four matched patients who underwent volarlocking plate fixation for isolated distal radius fractures during the same period were also reviewed. The clinical outcomes between the groups were compared using postoperative radiological parameters.
Results
The radiological assessment revealed a better radial length and inclination in the control group than in the study group at the final follow-up. In other words, patients with coincident hip fractures showed a higher tendency for loss of reduction. Despite the differences in radiological parameters, no significant differences in clinical outcomes were observed, except for grip strength.
Conclusion
Although volar-locking plating provides greater stabilization, a loss of reduction occurred in patients with coincident hip fractures.

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Osteoporotic Hip Fracture: How We Make Better Results?: Byung-Chan Choi, Kyung-Jae Lee; J Korean Fract Soc 2024;37(1):52-59. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.52

Abstract PDF: The prevalence of osteoporosis and incidence of osteoporotic fractures is increasing gradually as life expectancy is prolonged and the aged population increases. Osteoporotic hip fractures (femoral neck fractures and femoral intertrochanteric fractures) have high mortality because the patients with these fractures are elderly and have several comorbidities. Thorough preparation and a multidisciplinary approach in the preoperative period are critical, and early surgery is recommended. There are also several principles to treat osteoporotic hip fractures and prevent fixation failures. Many studies have suggested various treatment methods for femoral neck fractures and femoral intertrochanteric fractures. Functional recovery treatment is essential based on the patient’s health and activity levels. Finally, aggressive management of osteoporosis and the prevention of falling is needed to treat osteoporotic hip fractures successfully.

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Hip Fractures in the Elderly: Perioperative Management and Prevention of Medical Complications: Keong-Hwan Kim; J Korean Fract Soc 2023;36(1):39-44. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.39

Abstract PDF: Elderly patients with hip fractures are at an increased risk of developing medical complications with higher mortality rates. Most patients require surgical treatment, and an early surgical intervention can reduce complications and lower mortality risk. A restrictive red blood cell transfusion strategy is usually applied, and the amount of transfusion can be reduced through medications such as tranexamic acid. Delirium can be prevented using non-pharmacological methods. In addition, it is necessary to prevent venous thromboembolism through mechanical or chemical prophylaxis. A multidisciplinary approach using the ERAS (Enhanced Recovery After Surgery) protocol and orthogeriatric care can help to reduce medical complications and mortality.

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Comparison of the Clinical and Radiological Outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) Treatment in Elderly Patients with Intertrochanteric Fractures: Min Sung Kwon, Young Bok Kim, Gyu Min Kong; J Korean Fract Soc 2022;35(4):162-168. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.162

Abstract PDF

Purpose
Trochanteric fixation nail advanced (TFNA) was modified to compensate for the shortcomings of proximal femoral nail antirotation-II (PFNA-II). The clinical and radiological outcomes of surgeries us-ing the PFNA-II and TFNA for femoral intertrochanteric fractures were compared.
Materials and Methods
Eighty-two patients who underwent surgeries using PFNA-II or TFNA were analyzed. Only those who were followed up for more than a year were enrolled. Bone union, shortening of the femoral neck, and the tip–apex distance of the intramedullary nail were compared in the radiological findings. Clinical outcomes, including the frequency of complications and gait ability (Koval score), were also assessed.
Results
The mean follow-up periods were 22 and 19 months for the PFNA-II and TFNA groups, re-spectively. In the PFNA-II group, two cases of femoral head cut-out and one case of varus collapse were observed. In the TFNA group, only one case of femoral head cut-out was observed; however, there was no significant difference in the frequency of complications between the two groups (p=0.37). Ad-ditionally, both the shortening of the femoral neck and the decrease in gait ability after surgery showed relative improvement in the TFNA group compared to the PFNA-II group; however, there was no sig-nificant difference between the two groups.
Conclusion
The use of both TFNA and PFNA-II was associated with satisfactory outcomes. In patients who underwent surgeries using TFNA, the recovery of gait ability, frequency of complications, and short-ening of the femoral neck were not significantly different from PFNA-II, suggesting that both are suitable instrument choices for intertrochanteric fracture treatment. However, the clinical significance must be further assessed using a larger group of patients over a longer follow-up period in future studies.

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Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain
Sung Yoon Jung, Myoung Jin Lee, Lih Wang, Hyeon Jun Kim, Dong Hoon Sung, Jun Ha Park
Journal of the Korean Orthopaedic Association.2024; 59(3): 208. CrossRef

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Benefits of a Demineralized Bone Matrix in Osteoporotic Intertrochanteric Femoral Fracture Patients: Se Jin Kim, Hong-Man Cho, Myung Cheol Jung; J Korean Fract Soc 2022;35(4):151-161. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.151

Abstract PDF: Purpose
Osteoporosis causes various fixation failures in patients with intertrochanteric fractures. This study aimed to investigate the effect of a demineralized bone matrix (DBM) for cancellous or cortical bone defects on internal fixation in older osteoporotic patients with intertrochanteric fractures.
Materials and Methods
Among patients with intertrochanteric fractures who underwent surgical treatment from January 2016 to December 2021 at a facility, 171 patients were AO/OTA type 31-A1 and type 2 fractures which are considered relatively stable. The patients were grouped based on DBM use (Group A: DBM use, Group B: DBM non-use), and their clinical and radiology results were analyzed retrospectively. The patients were then subdivided into Group A-a and -b after removing factors that could cause treatment failures, such as the reduction status and location of the helical blade, and then further subdivided (Group A-a-1/2/3/4 and Group B-b-1/2/3/4) according to cancellous or cortical bone defects that could accompany intertrochanteric fractures. The time to full weight-bearing (FWB) and Harris hip score (HSS) 3 months after surgery in these subgroups were investigated.
Results
There was no significant difference in the clinical radiology results and complications between Group A and Group B. However, the time to FWB (p<0.001) and HSS (p=0.029) were significantly superior in Group A. In Group A-a with DBM use, after removing the risk factors for intertrochanteric fracture failure, the time to FWB (p=0.055) was close to the significance level, and HSS (p=0.036) was significantly superior. In Group A-a-1 (cancellous defect only) and Group A-a-3 (cancellous and cortical defect), the time to FWB (p=0.088, 0.052) was close to the significance level, and the HSS (p=0.039, 0.018) was significantly superior when DBM was used.
Conclusion
In patients with intertrochanteric fractures of AO/OTA type 31-A2.3 or less, if stable reduction and firm fixation are achieved, selective DBM use may help early recovery after surgery.

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Injury of the Ascending Branch of the Lateral Femoral Circumflex Artery Caused by a Spike of the Displaced Lesser Trochanter in an Intertrochanteric Femoral Fracture - A Case Report -: Soon Ho Huh, Hong-Man Cho, Jiyeon Park; J Korean Fract Soc 2021;34(2):71-75. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.71

Abstract PDF: Although vascular injuries associated with femoral intertrochanteric fractures have been reported infrequently, bleeding due to vascular injury can lead to severe complications that can be potentially life and limb-threatening. The authors report a case of an injury of the ascending branch of the lateral femoral convolutional artery in a patient who underwent surgical treatment for a femoral intertrochanteric fracture. Vascular injury occurred due to the sharp margin of displaced lesser trochanter five weeks after surgery. Percutaneous transcatheter embolization was done and improved without additional complications. Therefore, the surgeons need to be aware of possible associated vascular injuries caused by displaced lesser trochanter fragments in femoral intertrochanteric fractures.

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Treatment of Proximal Femur Fracture with a Newly Designed Nail: Trochanteric Fixation Nail-Advanced (TFNA): Jae Youn Yoon, Ji Wan Kim; J Korean Fract Soc 2020;33(4):189-195. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.189

Abstract PDF

Purpose
This study evaluated the clinical results and implant safety of a newly developed implant, Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes), in the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective cohort study of 26 patients diagnosed with proximal femur fracture and treated surgically with TFNA. The patients’ demographic data, surgical data, radiologic findings, and functional outcomes, including complications, were evaluated.
Results
The mean age of the patients was 71.2 years (95% confidence interval [CI], 68.2-74.2); 65.4% were female. The mean Carlson comorbidity index score was 5.4, and the mean Koval grade before fracture was 2.1. Fracture classification included four cases of AO/OTA 31.A1, nine cases of A2, six cases of A3, and seven cases of 32A including six cases of atypical femoral fractures. The mean operating time was 53.3 minutes (95% CI, 43.6-63.1). There were no early postoperative complications, such as postoperative infection, deep vein thrombosis, pulmonary embolism, or in-hospital death, except one case of pneumonia. The mean Koval score at the postoperative six-month follow-up was 2.9. EuroQol-5 Dimension (EQ-5D) increased from 0.05 to 0.54 after three months and 0.72 at six months postoperatively. Bone union was observed in all cases with a mean union time of 12.9 weeks. No implant failure occurred, and no cases required secondary revision surgery.
Conclusion
A new intramedullary nail system, TFNA, showed excellent outcomes and safety in the surgical treatment of proximal femur fractures.

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Intermediate Length Cephalomedullary Nails in Proximal Femoral Fractures: Review of Indications and Outcomes
Daniel Scott Horwitz, Ahmed Nageeb Mahmoud, Michael Suk
Journal of the American Academy of Orthopaedic Surgeons.2025;[Epub] CrossRef
Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain
Sung Yoon Jung, Myoung Jin Lee, Lih Wang, Hyeon Jun Kim, Dong Hoon Sung, Jun Ha Park
Journal of the Korean Orthopaedic Association.2024; 59(3): 208. CrossRef
Prospective randomized multicenter noninferiority clinical trial evaluating the use of TFN-advancedTM proximal femoral nailing system (TFNA) for the treatment of proximal femur fracture in a Chinese population
Lidan Zhang, Zhijun Pan, Xiaohui Zheng, Qiugen Wang, Peifu Tang, Fang Zhou, Fan Liu, Bin Yu, Frankie K. L. Leung, Alex Wu, Suzanne Hughson, Zhuo Chen, Michael Blauth, Anthony Rosner, Charisse Sparks, Manyi Wang
European Journal of Trauma and Emergency Surgery.2023; 49(3): 1561. CrossRef
Risk of shortening in operatively treated proximal femur fractures with cephalomedullary nails with dynamically versus statically locked helical blades
Nathan Cherian, Lasun Oladeji, Cole Ohnoutka, Dan Touhey, Madeline Sauer, Kyle A. Schweser, Mauricio Kfuri, James L. Cook, Gregory J. Della Rocca, Brett D. Crist
Injury.2023; 54(2): 669. CrossRef
GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures
Seungcheol Kwon, Minjae Lee, Heeyeon Lee, Jihyo Hwang
Journal of Clinical Medicine.2023; 12(21): 6720. CrossRef
Comparison of the Clinical and Radiological Outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) Treatment in Elderly Patients with Intertrochanteric Fractures
Min Sung Kwon, Young Bok Kim, Gyu Min Kong
Journal of the Korean Fracture Society.2022; 35(4): 162. CrossRef
Analysis of Clinical and Functional Outcomes according to the Blood Sugar Control Status at the Time of Ankle Fractures Resulting from Rotational Injuries
Jun Young Lee, Dong Seop Lim, Seung Hyun Lee, Seo Jin Park
Journal of the Korean Fracture Society.2022; 35(4): 135. CrossRef
Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation
Hong Man Cho, Kwang Min Park, Tae Gon Jung, Ji Yeon Park, Young Lee
BMC Musculoskeletal Disorders.2021;[Epub] CrossRef
Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee
Journal of the Korean Fracture Society.2021; 34(3): 105. CrossRef

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Treatment of the Proximal Femoral Fracture Using the New Design Cephalomedullary Nail: Prospective Outcomes Study: Young Ho Roh, Joseph Rho, Kwang Woo Nam; J Korean Fract Soc 2019;32(1):35-42. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.35

Abstract PDF

PURPOSE
The aim of this study is to investigate the clinical performance and safety of ZimmerÂ® natural nail cephalomedullary nail (ZNN CM nail) in the treatment of proximal femur fractures.
MATERIALS AND METHODS
The following research was conducted as a prospective, non-comparative, single center outcome study. Upon providing written informed consent, enrolled patients' data were collected and analyzed. Postoperative follow-up visits were scheduled at 6 weeks, 3 months, 6 months, and 1 year. Follow-up evaluation included radiographic assessment, physical examination, and quality of life and adverse events reports.
RESULTS
Thirty-nine patients were available for evaluation at one year postoperative. The patients reported the mean EuroQol-5 Dimension score increased after surgery: from 0.4 points at discharge (n=49) to 0.6 points at 1-year post-surgery (n=39). The mean Harris hip score also increased after surgery: from 56.3 points at discharge (n=49) to 72.1 points at 1 year (n=12). Bone union was seen in 64% (n=16) in 6 months and 95% (n=37) in 1 year.
CONCLUSION
The results of this 1-year follow-up study affirmed the effectiveness and safety of the ZNN CM nail in the treatment of proximal femur fractures.

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Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee
Journal of the Korean Fracture Society.2021; 34(3): 105. CrossRef
Treatment of Proximal Femur Fracture with a Newly Designed Nail: Trochanteric Fixation Nail-Advanced (TFNA)
Jae Youn Yoon, Ji Wan Kim
Journal of the Korean Fracture Society.2020; 33(4): 189. CrossRef

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Cognitive Impairment in Hip Fracture Patients without Underlying Neurologic Diseases: Risk Factors and Relationship to Early Functional Recovery: Preliminary Study: Jae Yong Park, Yong Beom Lee, Kun Tae Park, Je Hyun Yoo, Narei Hong; J Korean Fract Soc 2016;29(1):34-41. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.34

Abstract PDF Supplementary Material: PURPOSE
The aim of this study is to examine the risk factors of cognitive impairment in elderly hip fracture patients with no underlying neurologic disease, and to determine its effect on functional recovery postoperatively.
MATERIALS AND METHODS
From August 2012 to August 2013, 39 patients older than 65 years of age, who underwent hip fracture surgery and were followed-up for a minimum of 1 year at Hallym University Sacred Heart Hospital, were enrolled. All patients were assessed using Korean version of Mini-Mental State Examination (MMSE-K) after admission. All patients were divided into cognitive normal group (MMSE-K> or =24) and cognitive impairment group (MMSE-K<24). WOMAC (Western Ontario and McMaster University) score and Harris hip score were used for assessment of functional recovery at 6-month follow-up.
RESULTS
Sixteen patients (41.0%) were classified as the cognitive impairment group. The number of underlying diseases was the only statistically different factor between the two groups. In the evaluation of functional outcome, the functional decline was less in the cognitive normal group. Risk factors for cognitive impairment in elderly hip fracture patients were old age, high body mass index, and the number of underlying diseases, particularly an endocrinologic disease like diabetes.
CONCLUSION
Cognitive impairment in elderly patients may have a negative effect on functional recovery after hip fracture surgery. Therefore, we recommend routine evaluation of cognitive function in elderly hip fracture patients even with no underlying neurologic disease.

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Assessment of Coronal Plane Malalignment Following Reduction of Trochanteric Fractures-Simple Intraoperative Guideline Using Greater Trochanter Orthogonal Line: Young Cheol Yoon, Jong Keon Oh, Won Yong Shon, Han Ju Kim, Jae Woo Cho; J Korean Fract Soc 2016;29(1):1-11. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.1

Abstract PDF: PURPOSE
There is no consensus on a clear intraoperative guideline for judging the coronal plane alignment following reduction of trochanteric fractures. Complex angular measurements using fluoroscope monitors are tedious. Therefore the relation of the horizontal line from the tip of the greater trochanter (GT orthogonal) and femur head center (HC orthogonal) was studied to define this line as a criterion for predicting varus-valgus malalignment.
MATERIALS AND METHODS
We studied this relation in 200 standing orthoradiograms which included 100 males and 100 females. The images were digitally analyzed using the picture archiving and communication system. GT orthogonal line and HC orthogonal line were evaluated. The distance of these lines was measured as trochanter center distance (TCD) and its correlation with angular parameters like neck shaft angle, medial proximal femoral angle with reference to anatomical axis (aMPFA) and lateral proximal femoral angle with reference to mechanical axis (mLPFA) were analyzed.
RESULTS
In all patients, the GT orthogonal line passed either at or above the center of the head. Overall mean of TCD was 7.22 mm, ranging from 0 to 17.57 mm. TCD was found to show strong correlation with angular parameters like aMPFA, mLPFA and neck shaft angle. TCD was less than one fourth of the corresponding head diameter in around 90%. Therefore following reduction of trochanteric fractures, the GT orthogonal line should pass through the superior juxta central quadrant of the femoral head.
CONCLUSION
This line can be represented by a guide wire with fluoroscopy during surgery. The GT orthogonal line can be used intraoperatively as a simplified tool for prediction of varus/valgus malalignment following the reduction of trochanteric fractures.

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Simultaneous Bilateral Proximal Femoral Fracture associated with Generalized Tonic-Clonic Seizure: A Case Report: Sang Hoo Lee, Kyeong Seop Song, Seung Joo Jeon, Seong Hwan Hong; J Korean Fract Soc 2012;25(1):69-72. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.69

Abstract PDF: Simultaneous bilateral proximal femoral fractures are extremely rare, and a few have been reported in and outside the country. It may have various causes, and most cases were associated with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, and anti-epileptic medications. We experienced a case of simultaneous bilateral proximal femoral fractures after generalized tonic-clonic seizure in a 70-year-old female. Herein, we report it with a review of the literature.

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Morbidity and Mortality of Bilateral Hip Fractures in Elderly Patients: Suk Ku Han, Nam Yong Choi, Seong Jin Park, Seong Keun Lee, Chan Woong Moon; J Korean Soc Fract 2000;13(4):788-794. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.788

Abstract PDF

PURPOSE
The purpose of this study was to estimate the morbidity and mortality rate of bilateral hip fractures in elderly patients compared to that in unilateral hip fractures and to evaluate it's related risk factors.
MATERIALS AND METHODS
Twenty-two cases of bilateral hip fractures in patients who were older than 70 years with at least two year follow-up were included in our study. We analysed the risk factors of bilateral hip fractures by comparing with age, sex and diagnosis matched 22 cases of ipsilateral hip fractures including onset of secondary fracture, injury mechanism and the rate of morbidity and mortality, respectively.
RESULTS
The onset of secondary fracture and death were mostly within 1 year after operation for the first hip fracture. Comorbidity of cardiovascular, neurologic, urologic or history of previous fracture and decreased ambulation ability were related with the occurrence of bilateral hip fractures. The rate of morbidity and mortality of bilateral hip fractures were about two- fold than that of ipsilateral hip fractures. High mortality rate was noted in patients who had operation delay from injury. But no significant relationship between nutrition, body weight or bone mineral density and the development of secondary hip fractures.
CONCLUSION
To prevent the occurence of bilateral hip fractures which had more serious results than that of ipsilateral hip fractures, more aggressive rehabilitation to improve walking ability and appropriate environmental circumstances to avoid falls were important, especially in older patients.

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Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly
Duk-Hwan Kho, Ju-Yong Shin, Hyeung-June Kim, Dong-Heon Kim
The Journal of the Korean Orthopaedic Association.2009; 44(3): 369. CrossRef

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