In unstable femoral trochanteric fracture, we usually used transversing K-wires through the lesser trochanter to achieve an anatomical reduction, and using sliding hip screws. However, in patients with comminuted lesser trochanter or osteoporosis, an intrusion of the wire into the lesser trochanter and/or iatrogenic intertrochanteric fractures were often resulted. Those who were not familiar with a technique of puncturing two holes through the lesser trochanter might have had to face some difficulties. In order to overcome aforementioned drawbacks, the authors had quite satisfactory results by employing the method of passing each of two wires above and below the iliopsoas muscle, and they were twisted posteriorly and then anteriorly; and finally they were pulled together posteriorly. Through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.
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The lesser trochanter “Sling fixation technique” in proximal intramedullary nailing of unstable intertrochanteric fractures: A polymer-based cerclage wiring Marco Villano, Matteo Innocenti, Roberto Civinini, Christian Carulli, Alessandro Civinini, Zyad Ayman Taha, Andrea Cozzi Lepri Journal of Orthopaedics.2022; 34: 94. CrossRef
Unstable Intertrochanteric Fracture: Do We Know Everything? A Review Balaji Zacharia, Harshitha Hayavadana Udupa SN Comprehensive Clinical Medicine.2022;[Epub] CrossRef
When to Reduce and Fix Displaced Lesser Trochanter in Treatment of Trochanteric Fracture: A Systematic Review Ao-Lei Yang, Wei Mao, Jun-Guo Wu, Yi-Qun He, Hao-Fei Ni, Hai-Long Li, You-Hai Dong Frontiers in Surgery.2022;[Epub] CrossRef
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In response David J. Ciufo, John P. Ketz Journal of Orthopaedic Trauma.2018; 32(9): e382. CrossRef
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Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note Joong-Myung Lee, Yongsuk Cho, Junhyun Kim, Dong-Won Kim Hip & Pelvis.2017; 29(1): 44. CrossRef
Wiring technique for lesser trochanter fixation in proximal IM nailing of unstable intertrochanteric fractures: A modified candy-package wiring technique Gyeong Min Kim, Kwang Woo Nam, Kyu-Bum Seo, Chaemoon Lim, Jiyun Kim, Yong-Geun Park Injury.2017; 48(2): 406. CrossRef
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The fractures around the elbow joint in adults are relatively rare in comparision with that in children, but the late complications are more common in adult.
So, it is important to select the appropriate early management to prevent the late sequelae.
Complications are joint contracture, persistant pain, nonunion, deformity, neurologic symptom, infection. etc. Among them limited range of joint motion is the main problem.
We, authors have clinically and radiologically analyBed 48 cases of fracture around the elbow joint in adults over the age of 20 years, treated at the Department of Orthopaedic Surgery in National Medical Center from January 1984 through December 1993.
The results are as follows: 1. The age incidence was higher in active young persons and the male to female ratio was 3:2.
2. The most common cause of the injury was slip-down(46%), followed by traffic accident(29fo), falling, and athletic injury.
3. In total 48 cases, olecranon fractures were 29 cases, fractures of distal humerus 13 cases, radial head fractures 5 cases, and multiple fractures (including olecranon, radial head and intercondyle) was 1 case, Among them. open fractures were 5 cases.
4. Closed reduction with cast immobilization or K-wire fixation was performed in 8 cases, and open reduction and internal fixation was performed in 37 cases. In 3 cases. radial head resection was done.
5. The most common complication was limited range of the joint motion (9cases), followed by nerve injury(3 cases), infection(3 cases) and nonunion(1 cases).
6. Development of limited range of joint motion was increased in case of old age over 60 years(33%), open fracture(60%), longer immobilization period over 6 weeks(27%).
Though fracture around the elbow joint in adult is reletively rare. it frequently results in limitation of the joint motion and has poor prognosis For prevention of limitation of joint motion, rigid fixation and shortening of immobilization period and early rehabilitation are necessary.
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Treatment of Ulnar Olecranon Fracture Using Acutrak Screw Hyungchun Kim, Kwangryul Kim, Moonsup Lim, Youngil Park, Inhwan Hwang, Jihoon Lee Journal of the Korean Fracture Society.2009; 22(4): 270. CrossRef