Journal of Musculoskeletal Trauma

Delayed Pseudoaneurysm of Deep Femoral Artery Caused by Migration of Lesser Trochanter, Subsequent to an Intertrochanteric Fracture Surgery - A Case Report -: Bum-Soo Kim, Seong-Tae Kim, Seungyup Shin, Chang Geun Yu; J Korean Fract Soc 2021;34(2):76-79. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.76

Abstract PDF: The lesser trochanteric fracture is commonly found amongst intertrochanteric fractures, where pseudoaneurysm of the femoral artery is a rare complication. A pseudoaneurysm could develop due to the penetration injury of the artery by the bone fragment during occurrence of the fracture, or by the insertion of screws during the surgical procedure. Minimal complication is seen when the lesser trochanter is not fixed during the intertrochanteric fracture surgery. However, in the current case, the authors experienced appearance of a delayed pseudoaneurysm of the deep femoral artery caused by migration of the lesser trochanter, which was successfully treated by excision.

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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

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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Delayed Deep Femoral Artery Injury Secondary to Migrated Lesser Trochanter Fragment After Intertrochanteric Fracture Fixation: A Case Report and Updated Literature Review
Slavko Čičak, Josip Kocur, Vedran Farkaš, Petra Čičak, Stjepan Ištvanić, Marko Lovrić, Marko Perić, Nenad Koruga, Tomislav Ištvanić
Geriatric Orthopaedic Surgery & Rehabilitation.2025;[Epub] CrossRef

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New Wiring Method for Lesser Trochanter Fixation in Unstable Intertrochanteric Fractures: Technical Note: Joong Myung Lee, Jeong Hee Lee, Churl Woo Lee, Hyun Min Kim; J Korean Fract Soc 2005;18(2):209-212. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.209

Abstract PDF

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
Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: a notable preoperative risk factor for implant failure
Pengfei Li, Yang Lv, Fang Zhou, Yun Tian, Hongquan Ji, Zhishan Zhang, Yan Guo, Zhongwei Yang, Guojin Hou
Injury.2020; 51(3): 683. CrossRef
In response
David J. Ciufo, John P. Ketz
Journal of Orthopaedic Trauma.2018; 32(9): e382. CrossRef
Three-Dimensional Computed Tomography Reduced Fixation Failure of Intramedullary Nailing for Unstable Type of Intertrochanteric Fracture
Wei-Yu Li, Kai-Cheng Lin
Journal of Orthopaedic Trauma.2018; 32(9): e381. CrossRef
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
Bipolar Hemiarthroplasty with Cementless Femoral Stem for Unstable Intertrochanteric Fractures
Joong-Myung Lee, Hee-Tae Nam, Sang-Hun Lee
Journal of the Korean Orthopaedic Association.2012; 47(2): 79. CrossRef

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Analysis of cause of collapse and Non-union After Internal Fixation of Intertrochanteric Fracture: Seung Woo Suh, Chang Ryong Hur, Jung Ho Park, Jun Seok Hong, Woo Nam Moon; J Korean Soc Fract 1999;12(4):812-817. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.812

Abstract PDF: Sixty-five Intertrochanteric hip fractures were analyzed radiologically to study the factors affecting postoperati ye stability. Fractures were evaluated by measuring shortening and angulation, collapse of telescoping device when utilized, and migration of the fixation device within the femoral head. Fractures were classified according to their stability preoperatively and the reduction of lessor trochanteric fracture fragment postoperatively. The failure rate and postoperative stability were then compared on terms of severity of osteoporosis, type of fracture, existence of reduction of lestor trochanter fragment.
Results
indicated that the severity of osteoporosis was not related to the group of fracture, which determines stability of fracture. Regarding the rate of bone union, anatomically reduced groups showed similar rates of bone union(73.8% in average) and degree of sliding of lag screw (4.13mm in average) regardless of fixation of lesser trochanter fragment. On the other hand, malreduced group which failed to obtain anatomical reduction had 26.1% of bone union rates and 10.95mm of sliding of lag screw representing importance of anatomical reduction rather than fixation of lesser trochanteric fracture. In conclusion, there was no correlationthip between severity of oLteoporosis and type of fracture. And it is suggested that unstabae intertrochanteric fractures accompanied by large lesser trochanteric fracture fragment can be provided stability avoiding major complications such as loosening of implant or collapse of fracture fragment if it is fixed with anatomical reduction of fracture even without the fixation of lesser trochanteric fragment.

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Effect of Unreduced Lesser Trochanteric Fracture on Stability in Intertrochanteric Fracture of Femur: Seung Woo Suh, Jeong Ho Park, Jong Kun Oh, Kyung Wook Nah, Tae Hyeon Kim, Woo Nam Moon; J Korean Soc Fract 1997;10(3):529-533. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.529

Abstract PDF: Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Stability can be provided by transfixion of the lesser trochanteric fracture fragment with a screw. However, fixation of lesser trochanteric fragment is difficult, time-consuming, and often unsuccessful. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. A radiological review of 61 intertrochanteric fractures treated with compression screw was made to study the effect of unreduced lesser trochanteric fracture on fracture healing and stability in unstable intertrochanteric fractures accompanied by lessor trochanteric fracture. Analysis were made on terms of rate of bone union, maintenance of reduction by comparing between anatomically reduced group with/without lesser trochanteric fracture and malreduced group with lesser trochanteric fracture. Anatomically reduced groups with/without lessel trochanteric fracture showed similar rates of bone union(88.3% in average) and degree of sliding of lag screw(3.74mm in average) regardless of fixation of lesser trochanter. On the other hand, unreduced group had 33.3% of bone union rates and 9.80mm of sliding of lag screw representing importance of anatomical reduction rather than fixation of lesser trochanteric fracture. In conclusion, it is suggested that unstable intertrochanteric fractures accompanied by large lesser trochanteric fracture fragment can be treated without fixation of lesser trochanteric fragment avoiding major complicatioins such as loosening of implant or collapse of fracture fragment.

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