PURPOSE To evaluate the radiographic results of patients with subtrochanteric femoral fracture using minimal incision and cephalomedullary nail technique. MATERIALS AND METHODS This study was performed on 54 patients, 54 cases of hip, recruited among patients who underwent minimal incision and Cephalomedullary nail from September 2005 to August 2008 and were available for 1-year or longer follow up. The gender ratio was 37 males and 17 females, and the mean age at the time of surgery was 57.4 years (range; 16~81 years). According to injury mechanism, traffic accident was 29 cases, fall down form high height was 18 cases, slip down was 7 cases. In classification by Seinsheimer, type II was 23 cases (m/c), type III was 18 cases, type IV was 13 cases. Average follow up period was 14 months (12~18). Radiographic evaluation was performed for time taking union, mal-union and complication. RESULTS 53 of the 54 cases united. 39 of 54 reductions were anatomic. 19 fractures had a monir varus deformity of proximal fragment (between 2degrees and 5degrees). There was no varus deformity of more than 5degrees. 1 case that had been treated with PFN had nail breakage without trauma. There were no other complications. CONCLUSION Surgical treatment of subtrochanteric fractures with minimal incision and Cephalomedullary nail technique can reslut in excellent reduction without complications including inflammation & malunion. Careful attention to detail for using Lowman clamp is demanding to decrease soft tissue injury.
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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation Chi Hyoung Pak, Sang Hong Lee, Sang Ho Ha, Gwang Chul Lee, Kyoung Chul Song Journal of the Korean Fracture Society.2013; 26(4): 284. CrossRef
Fixation of the Femoral Subtrochanteric Fracture with Minimally Invasive Reduction Techniques Chul-Hyun Park, Chul-Wung Ha, Sang-Jin Park, Min-Su Ko, Oog-Jin Shon Journal of the Korean Fracture Society.2013; 26(2): 112. CrossRef
Flexible intramedullary nailing has offered the many advantages in the treatment of the trochanteric fractures. But there has been many complications such as the knee joint pain, the deformity of external rotation of the femur, insufficient fixation of the fracture, peroneal nerve palsy, cortical breakage of insertion site of nailing and linear fracture of the femur.
Of these complications, the cortical breakage and linear fractures of the femur was prevented by suing the Lownam clamp on the proximal site of insertion hole during the nailing.
The authors have treated 31 cases of the trochanteric fractures with this method from March 1985 to December 1988 and the results are as follows: 1. There was neither cortical breakage nor linear fracture at the site of insertion hole in all cases of 31.
2. wide operation field was obtained with Lowman clamp by traction of muscles near by.
3. The handle of Lowman clamp can be used as indicator to determine the grade of anteversion.
4. It is confirmed that intramedullary nailing with Lowman clamp is simpler than conventional method and is highly recommended.