Journal of Musculoskeletal Trauma

Failure of Intramedullary Nailing for Subtrochanteric Atypical Femoral Fractures Caused by Endosteal Cortical Thickening: Young Ho Roh, Kimoon Kang, Hee Joong Kim, Kwang Woo Nam; J Korean Fract Soc 2019;32(4):211-221. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.211; Correction in: J Musculoskelet Trauma 2020;33(1):63

PURPOSE
Recent literature has noted incidences of subtrochanteric atypical femoral fractures (AFFs) in patients who have taken long-term bisphosphonates (BPs). Most cases of subtrochanteric AFFs have been treated with intramedullary nailing and cases of delayed union have been reported. On the other hand, there is no data available on the complications associated with endosteal thickening or cortical thickening. This study evaluated the results of surgical treatment according to the endosteal thickening of the lateral cortex in subtrochanteric AFFs.
MATERIALS AND METHODS
Investigation was performed at the Department of Orthopaedic Surgery, Jeju National University Hospital. The study consisted of patients with subtrochanteric AFFs, defined by the American Society for Bone and Mineral Research (ASBMR) major criteria, who underwent intramedullary nailing from March 2012 to October 2014. The cases were categorized into two groups based on the presence of endosteal thickening. The evaluation included the demographic data, radiographic data of initial reduction state, and duration of BPs.
RESULTS
The demographic data and duration of BPs were similar in the two groups. On the other hand, varus reduction (Group I: 12.5% vs. Group II: 78.9%; p=0.001), delayed union (Group I: 0% vs. Group II: 70.0%; p=0.003), nonunion (Group I: 0% vs. Group II: 47.4%; p=0.017), and union time (Group I: 5.5 months vs. Group II: 8.3 months; p<0.001) were significantly different in the two groups.
CONCLUSION
Endosteal thickening of the lateral cortex in subtrochanteric AFFs was identified as an independent factor that decides the reduction of the fracture and nonunion. The endosteal thickening should be removed to obtain anatomical alignment for successful surgical results.

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Controlled bending of proximal femoral nails used in fractures of bowed femurs: biomechanical study with clinical application
Hong Moon Sohn, Suenghwan Jo
Medical Biological Science and Engineering.2022; 5(2): 63. CrossRef

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Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note: Gyu Min Kong; J Korean Fract Soc 2019;32(2):107-111. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.107

Abstract PDF: The subtrochanteric area is the place where mechanical stress is most concentrated in the femur. When a fracture happens, bone union is delayed and nonunion often occurs. The recommended treatment for atypical fractures is an anatomical reduction of the fracture site as the frequency of nonunion is higher than that of ordinary fractures. Various reduction methods have been suggested, and good results have been obtained. On the other hand, the occurrence of posterior displacement of the distal fragment during the insertion of an intramedullary nail is often overlooked. This is probably because the bone marrow of the femur tends to form an elliptical shape in the anteroposterior direction. The author attempted to insert a blocking screw into the distal part of the fracture to prevent posterior displacement of the distal fragment while performing intramedullary nailing of the femur fracture and achieved a good reduction state easily.

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Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal: Young Yool Chung, Dong Hyuk Choi, Dae Hyun Yoon, Jung Ho Lee, Ji Hun Park; J Korean Fract Soc 2015;28(2):103-109. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.103

Abstract PDF: PURPOSE
The purpose of this study is to analyze the clinical results of fixation using Sirus(R) nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal.
MATERIALS AND METHODS
From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus(R) nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared.
RESULTS
The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment.
CONCLUSION
Using Sirus(R) nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

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Steinmann Pin Assisted Reduction of Subtrochanteric Femoral Fracture: Seung Wan Lim, Oog Jin Shon; J Korean Fract Soc 2015;28(1):17-22. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.17

Abstract PDF

PURPOSE
Nail insertion is the treatment of choice for subtrochanteric femoral fracture, but displacement of proximal bone fragment makes it difficult to find an ideal entry point. Therefore, in this study we aimed to determine the usefulness of treatment of subtrochanteric femoral fracture using Steinmann pin assisted reduction, internal fixation, and insertion of intramedullary nails.
MATERIALS AND METHODS
We evaluated 33 patients who were followed-up more than a year with a displaced subtrochanteric femoral fracture treated with closed reduction and intramedullary nail fixation between January 2008 and March 2013. In addition, we studied postoperative bone union time, postoperative reduction status, change of the femur neck shaft angle, evaluation of hip joint function, return to daily life, and complications.
RESULTS
All fractures with Steinmann pin assisted reduction were united but they included three cases of delayed union. In Fogagnolo classification, all cases were up to acceptable states and the varus change of femur neck shaft angle was 0.94degrees+/-3.1degrees; no significant difference in Harris hip score was observed between preoperative and last follow-up (p>0.05).
CONCLUSION
There were satisfactory results in bone union and reduction state with Steinmann pin assisted reduction. Therefore, Steinmann pin assisted reduction is a useful surgical technique for subtrochanteric femoral fracture.

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Percutaneous acetabular anchoring pin-assisted cephalomedullary nailing for subtrochanteric and unstable intertrochanteric fractures
Keong-Hwan Kim, Youngsik Yoon, Eic Ju Lim
Injury.2020; 51(3): 769. CrossRef

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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; J Korean Fract Soc 2013;26(4):284-291. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.284

Abstract PDF

PURPOSE
The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA).
MATERIALS AND METHODS
Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication.
RESULTS
Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion.
CONCLUSION
With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.

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Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note
Gyu Min Kong
Journal of the Korean Fracture Society.2019; 32(2): 107. CrossRef

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Efficacy of Percutaneous Cerclage Wiring in Intramedullary Nailing of Subtrochanteric Femur Fracture: Technical Note: Ki Chul Park, Hee Soo Kim; J Korean Fract Soc 2013;26(3):212-216. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.212

Abstract PDF

The subtrochanteric fractures of femur have high rates of delayed union or nonunion due to less-dense cancellous bone, insufficient cortical blood flow and high stress concentration. Anatomical reduction and rigid internal fixation are important in this region; however, an open reduction might damage the biological environment at the fracture site as well as increase the risk of nonunion. We present our experience with nine cases of subtrochanteric femur fractures surgically fixated with intramedullary nailing after percutaneous cerclage wiring through minimal incision.

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The stabilising effect by a novel cable cerclage configuration in long cephalomedullary nailing of subtrochanteric fractures with a posteromedial wedge
Pavel Mukherjee, Jan Egil Brattgjerd, Sanyalak Niratisairak, Jan Rune Nilssen, Knut Strømsøe, Harald Steen
Clinical Biomechanics.2019; 68: 1. CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef

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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; J Korean Fract Soc 2013;26(2):112-117. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.112

Abstract PDF

PURPOSE
To evaluate the results of using minimally invasive reduction techniques in patients with femoral subtrochanteric fracture.
MATERIALS AND METHODS
We retrospectively analyzed 40 patients (41 cases) with subtrochanteric fracture who underwent using minimally invasive reduction techniques. The mean age was 61.4 years (15-89 years), and the mean follow-up period was 32.7 months (12-66 months). Clinical results were assessed using the Parker-Palmer mobility score and the Salvati-Wilson hip functional score. Radiographic results were evaluated using bone union time and femur neck-shaft angle.
RESULTS
No significant difference was observed in the pre- and postoperative Parker-Palmer mobility score. Salvati-Wilson hip functional score showed more than good grade in 37 cases (90%) at the last follow-up. Union was achieved in all 41 cases at an average of 22.5 weeks (18-30 weeks). The mean femoral neck-shaft angle immediately postoperatively was 128.8 degrees (120-140 degrees), and the mean difference versus contralateral sides was 2.5 degrees varus (-6-13 degrees).
CONCLUSION
Fixation of femoral subtrochanteric fracture using minimally invasive reduction techniques showed excellent clinical and radiographic results and low complication rate.

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Effects of Yuhyangjeongtong-san on Fracture Healing in Rats
Ki-Tae Kim, Na-Young Jo
Journal of Korean Medicine.2019; 40(4): 61. CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef

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Deep Femoral Vessel Injury Following Subtrochanteric Hip Fracture: A Case Report: Jae Hyuk Yang, Jung Ro Yoon, Kyu Bok Kang, Ho Hyun Yun, Young Soo Shin, Yun Ku Cho; J Korean Fract Soc 2012;25(1):64-68. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.64

Abstract PDF

Arterial trauma associated with hip fracture treatment is still a rare complication. We present a case in which an arterial injury was discovered during closed reduction and intramedullary nail fixation of a subtrochanteric hip fracture. The preoperative thigh circumference was increased due to severe swelling, and the vascular injury was located substantially proximal to the fracture and the instrumentation area. An interventional angiogram revealed a damaged vessel originating from one of the minor proximal branches of the right deep femoral artery while filling a 2 cm-sized pseudoaneurysm. Embolization was performed without further complications.

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Proximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes
Antonio Barquet, Andrés Gelink, Peter V. Giannoudis
Injury.2015; 46(12): 2297. CrossRef
Pertrochanteric Hip Fracture: A “Routine” Fracture With a Potentially Devastating Vascular Complication
Matthew Patrick Sullivan, Mara Lynne Schenker, Samir Mehta
Orthopedics.2015;[Epub] CrossRef

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The Treatment of Subtrochanteric Fracture with Cephallomedually Nail: Minimal Incision and Lowman Clamp Assisted Reduction: Jang Seok Choi, Do Hyun Moon, Young Tae Noh; J Korean Fract Soc 2011;24(4):301-306. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.301

Abstract PDF

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

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Helical Blade versus Lag Screw for Treatment of Intertrochanteric Fracture: Kwang Jun Oh, Sung Tae Lee, Suk Ha Lee, Jin Ho Hwang, Min Suk Kang; J Korean Fract Soc 2010;23(1):6-12. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.6

Abstract PDF

PURPOSE
To evaluate the radiographic and functional outcomes between who had unstable intertrochanteric fracture, treated with the ITST (lag screw design) and the PFNA (helical blade design).
MATERIALS AND METHODS
We selected each 17 and 13 patients of unstable intertrochanteric fracture which were treated with ITST or PFNA from April 2005 to December 2008. We evaluated the radiographic results by follow-up radiography and the clinical outcomes with the mobility score of Parker and Palmer, Social function scoring system.
RESULTS
The mean sliding distance of cervical screw with ITST nails was not shown significant differences than with using PFNA nails. The other factors were not statistically different. Decrease of mobility score of Parker and Palmer, Social function score were similar. 2 cases of cutting out was noted with ITST nails and 1 case of cutting out was noted with PFNA nails.
CONCLUSION
Unlike the existed biomechanical reposts, there are no differences that are clinical and radiological results in treatment of unstable intertrochanteric fracture using the ITST nails and PFNA nails.

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Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis
Chul-Ho Kim, Han Soul Kim, Yong-Chan Kim, Dou Hyun Moon
Journal of Orthopaedic Trauma.2021; 35(8): 401. CrossRef
Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
Jae-Cheon Sim, Tae-Ho Kim, Ki-Do Hong, Sung-Sik Ha, Jong-Seong Lee
Journal of the Korean Fracture Society.2013; 26(1): 37. CrossRef
Treatment of Intertrochanteric Fractures Using Targon Proximal Femoral Nails
Il Ho Park, Jong Kyoung Won, Kye Young Han
Hip & Pelvis.2012; 24(2): 117. CrossRef

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The Comparison between ITST(TM) (Intertrochanteric/Subtrochanteric) & DHS (Dynamic Hip Screw) in Unstable Femur Intertrochanteric Fracture: Ho Seung Jeon, Byung Mun Park, Kyung Sub Song, Hyung Gyu Kim, Jong Ju Yun; J Korean Fract Soc 2009;22(3):131-137. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.131

Abstract PDF

PURPOSE
To evaluate between DHS and ITST nail (2nd generation) on the treatment of unstable femur intertrochanteric fracture in patients over 70 years old.
MATERIALS AND METHODS
61 cases of unstable intertrochanteric fracture (grouped 37 patients with DHS and 24 patients with ITST) who were taken the operation from Mar. 2003 to Sep. 2007 were analysed regarding to union time, sliding length of lag screws, operation time, blood loss, postoperative complications and functional recovery score by Skovron.
RESULTS
The mean union time was 14.7 weeks in study group (ITST). The mean union time was 16.2 weeks in control group (DHS). The lag screw slidings were 7.2 mm in study group and 8.7 mm in control group. The operation times were 57.9 min in study group and 76.9 min in control group. The amount of blood loss were 67.7 ml in study group and 227.4 ml in control group. The complications were 4 cases in study group and 4 cases in control group. The Skovron recovery scores were 76.5% in study group and 73.7% in control group.
CONCLUSION
From a practical point of short operation time, less amount of bleeding and less complication, author think that the ITST nail is useful implant for treatment of unstable femur intertrochanteric fracture in patient of old age.

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Unstable Intertrochanteric Fracture Treated with ITST: A Comparative Study between Groups with and without Comminution of Greater Trochanter
Kyung-Sub Song, Sang-Ho Lee, Seong-Hun Jeong, Su-Keon Lee, Sung-Ha Hong
Journal of the Korean Fracture Society.2014; 27(1): 36. CrossRef
Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation
Gu-Hee Jung
Journal of the Korean Fracture Society.2011; 24(3): 223. CrossRef

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Operative Treatment with ITST in Femur Trochanteric Fracture: Ki Do Hong, Jae Chun Sim, Sung Sik Ha, Jae Young Kim, Jung Ho Kang, Kwang Hee Park; J Korean Fract Soc 2008;21(4):274-278. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.274

Abstract PDF

PURPOSE
To evaluate the clinical and radiographic results of treatment of trochanteric fracture with ITST (Intertrochanteric/ Subtrochanteric) nail.
MATERIALS AND METHODS
We reviewed the results of 40 cases of trochanteric fracture treated with ITST from January 2006 to May 2007, which could be followed up for more than 12 months. The cases include 13 males and 27 females, and the mean age is 75.6 years old. The clinical results were evaluated by Ceder mobility assessment, and the radiographic results were evaluated by the change of femoral neck-shaft angle and sliding of lag screw.
RESULTS
The mean bone union time is 13.5 weeks. Thirty four cases (85%) were recovered to pre-injury state of walking ability. The change of neck-shaft angle was an average of 5.21degrees and the sliding distance of lag screw was an average of 5.78 mm. Complications were occurred in 4 patients (10%).
CONCLUSION
The ITST nail were seen good results in treatment of trochanteric fracture and has relatively less complications than other internal fixator.

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Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation
Gu-Hee Jung
Journal of the Korean Fracture Society.2011; 24(3): 223. CrossRef

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Treatment of Subtrochanteric Femur Fractures Using Intramedullary Devices: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Chong Suk Park, Sang Ho Lee; J Korean Fract Soc 2008;21(1):13-18. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.13

Abstract PDF

PURPOSE
The purpose of this study is to compare the result between closed reduction and minimal open reduction in case of difficult reduction for subtrochanteric fractures fixed with intramedullary nail.
MATERIALS AND METHODS
From Jan. 2001 to May 2005, 35 cases of subtrochanteric femur fracture treated by intramedullary nail and followed up for more than a year were selected out of 42 subtrochanteric femur fractures. Fielding classification and Russel-Taylor classification were used, and according to the fracture classification and method of reduction, the patients were grouped into closed or open reduction group. Fracture with minimal displacement or anatomical reduction was fixed by closed reduction, but in case of failed closed reduction or loss of reduction, minimal incision was made for open reduction and internal fixation, and the result between two groups were compared.
RESULTS
In total of 35 cases, 15 cases were fixed by closed reduction and the rest 20 cases required open reduction. Operation time, amount of transfusion, total hospital days, partial weight bearing ambulation, and union time did not show significant differences between two groups. Ambulation and range of motion after the operation were satisfying in both groups.
CONCLUSION
In treatment of subtrochanteric femur fracture with intramedullary nail, both closed and open reduction shows satisfying result, therefore when anatomical reduction is difficult to achiev by closed reduction, minimal incision open reduction and additional fixation is strongly recommended to obtain anatomical reduction and firm fixation.

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Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. 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
Treatment of Subtrochanteric Nonunion with a Blade Plate
Youn-Soo Park, Jin-Hong Kim, Kyung-Jea Woo, Seung-Jae Lim
Journal of the Korean Orthopaedic Association.2011; 46(1): 42. CrossRef

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Comparison Study of Intertrochanteric Fractures Treated with Intertrochanteric/subtrochanteric Fixation with a Standard vs a Mini-incision: Se Dong Kim, Oog Jin Sohn, Jae Ho Cho; J Korean Fract Soc 2008;21(1):1-7. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.1

Abstract PDF

PURPOSE
To evaluate the radiographic, clinical results between who had intertrochnateric fracture, treated with ITST with a standard or a mini-incision.
MATERIALS AND METHODS
We selected each 20 patients of intertrochanteric fracture which were treated with ITST with a standard incision or a mini-incision from June 2004 to July 2006. We compared of mean operative time, transfusion doses and postoperative VAS score between two groups. We evaluated the radiographic results by follow-up radiography and the clinical results with the mobility score of Parker and Palmer and Salvati and Wilson hip function scoring system.
RESULTS
Mean operative time, transfusion doses and postoperative VAS score were significantly less in the mini-incision there were 87.8 min., 2.0 pints and 4.2 for the standard group versus 40.3 min., 1.1 pints and 3.3 for the mini group. The radiographic results were not significantly different. Decrease of mobility score of Parker and Palmer and Salvati and Wilson hip function scoring system were similar.
CONCLUSION
Mini-incision significantly reduces operative time, transfusion doses and postoperative pain for fixation intertrochanteric fracture treated with ITST.

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Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation
Gu-Hee Jung
Journal of the Korean Fracture Society.2011; 24(3): 223. CrossRef

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Minimally Invasive Plate Osteosynthesis for Comminuted Subtrochanteric Fracture of the Femur: Chang Wug Oh, Jong Keon Oh, Sung Jung Kim, Shin Yoon Kim, Seung Hoon Baek, In Ho Jeon, Poong Taek Kim, Sang Won Lee; J Korean Fract Soc 2006;19(4):407-411. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.407

Abstract

PURPOSE
To evaluate the outcomes of patients with comminuted subtrochanteric femoral fractures using minimally invasive plate osteosynthesis (MIPO) technique.
MATERIALS AND METHODS
Twelve patients with a mean age of 38.2 years, who sustained comminuted subtrochanteric femoral fractures, were treated using MIPO technique. All patients suffered these fractures either from traffic accidents (6) or falls from height (6). Average follow-up was 4.3 years (range, 29~78 months). Patients were assessed radiographically and clinically with regards to time to union, malunion, and complications. According to the Seinsheimer's classification, there were 1 type III, 7 type IV, and 4 type V. Type C fractures were ten according to AO-OTA classification.
RESULTS
Union was achieved in 7 of 12 cases, in an average of 23.4 weeks (range, 12~42 weeks). Three definite non-unions with implant failures, needed the procedure of implant change and bone graft. In other two patients, early bone graft was performed for anticipated nonunion of comminuted area. The most common complication was metal failures (2 plate failures and 3 screw breakages). Limb length shortening of 1.5 cm occurred in one patient, and external rotation malunion of 15 degrees was noted in one patient. No patients developed infection.
CONCLUSION
Preserving biology of the fracture fragments, the use of MIPO technique using DCS has proven to be less successful in comminuted subtrochanteric fractures, comparing to fractures in other areas. To avoid mechanical failure, the careful and protective weight bearing is needed until the callus-bridging is seen in the commniuted area.

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Minimally Invasive Plate Osteosynthesis for Femoral Mid-Diaphyseal Fractures
Hyoung-Keun Oh, Suk-Kyoo Choo, Jong-In Kim, Sung-Jong Woo
Journal of the Korean Fracture Society.2013; 26(2): 140. 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
Minimally Invasive Plate Osteosynthesis of Subtrochanteric Femoral Fractures
Chang-Wug Oh
Journal of the Korean Fracture Society.2009; 22(2): 123. CrossRef
What is an Ideal Treatment?
Chang-Wug Oh
Journal of the Korean Fracture Society.2008; 21(4): 347. CrossRef

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Subtrochanteric Fracture after Cannulatd Screw Fixation of Femoral Neck Fracture in a Child: A Case Report: Moo Sam Seo, Han Seong Park, Dae Won Jeong; J Korean Fract Soc 2006;19(3):392-395. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.392

Abstract: Though femoral neck fractures in adults are usually treated by fixation with multiple screws, subtrochanteric fracture at the insertion site is an uncommon complication, and in children, there has been a few reports about this complication after treatment of slipped capital femoral epiphysis. We report a subtrochanteric fracture at the insertion site of cannulated screws used in femoral neck fracture of a 9-years old boy.

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A Comparative Study of Trochanteric Fractures Treated with the Intertrochanteric/subtrochanteric Fixation or the Proximal Femoral Nail: Oog Jin Sohn, Sae Dong Kim, In Whan Kim, Seong Joon Byun; J Korean Fract Soc 2006;19(3):303-308. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.303

Abstract

PURPOSE
To evaluate the radiographic, clinical results and the complications between who had intertrochanteric fracture, treated with the ITST or the PFN.
MATERIALS AND METHODS
We selected each 30 patients of intertrochanteric fracture which were treated with ITST or PFN from July 2002 to November 2005. We evaluated the radiographic results by follow-up radiography and the clinical results with the mobility score of Parker and Palmer, Salvati and Wilson hip function scoring system and Jensen index.
RESULTS
The mean distance of lag screw sliding was 4.1 mm at the ITST group and 6.6 mm at the PFN group. Decrease of mobility score of Parker and Palmer, Salvati and Wilson hip function score were similar. Patients complaint pain over lateral thigh area in 5 cases (ITST group) and 8 cases (PFN group).
CONCLUSION
The ITST nail and PFN were seen good results in treatment of stable and unstable intertrochanteric fracture.

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Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Dae Jung Huh
Hip & Pelvis.2013; 25(1): 51. CrossRef
Minimally Invasive Plate Osteosynthesis of Subtrochanteric Femoral Fractures
Chang-Wug Oh
Journal of the Korean Fracture Society.2009; 22(2): 123. CrossRef
The Comparison between ITST™ (Intertrochanteric/Subtrochanteric) & DHS (Dynamic Hip Screw) in Unstable Femur Intertrochanteric Fracture
Ho-Seung Jeon, Byung-Mun Park, Kyung-Sub Song, Hyung-Gyu Kim, Jong-Ju Yun
Journal of the Korean Fracture Society.2009; 22(3): 131. CrossRef
Comparison Study of Intertrochanteric Fractures Treated with Intertrochanteric/subtrochanteric Fixation with a Standard vs a Mini-incision
Se Dong Kim, Oog Jin Sohn, Jae Ho Cho
Journal of the Korean Fracture Society.2008; 21(1): 1. CrossRef
Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail
Dong-Hui Kim, Sang-Hong Lee, Young-Lae Moon, Jun-Young Lee, Kun-Sang Song
Journal of the Korean Fracture Society.2007; 20(3): 215. CrossRef

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Treatment of Comminuted Subtrochanteric Fractures of the Femur by High-Energy Trauma: Taek Soo Jeon, Woo Sik Kim, Sang Bume Kim, Cheol Mog Hwang, Kyu Tae Kim, Sun Hong Kim; J Korean Fract Soc 2006;19(2):135-140. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.135

Abstract

PURPOSE
The purpose is to evaluate the effectiveness of open reduction and internal fixation in comminuted subtrochanteric fractures caused by high energy trauma at a non-osteoporotic young age.
MATERIALS AND METHODS
Of all cases of subtrochanteric fractures caused by high energy trauma under 60 years old from February 2000 to February 2004, we analyzed 16 patients who had severe comminuted fractures (Seinsheimer classification type IV, V). The mean age is 43.5 (31~54) years old. Mean follow-up period was 22 (14~38) months. We tried to reduce anatomically as much as possible and fixed firmly using a compression hip screw in all cases. Additional procedures such as interfragmentary screw fixation, cerclage wiring or lateral stabilization plating were performed in 13 cases. Bone grafting was performed in 8 cases. We evaluated bony union rate, time to union, status of reduction, varus deformity and rate of implant failure using a simple X-ray. We also analyzed the clinical result using the Harris hip score including range of motion, pain and limping gait, so on.
RESULTS
In all 16 cases, bony union was achieved and the mean time to union was 24 (20~32) weeks. There was no intra-operative complication. Postoperative complications such as loss of reduction, varus deformity, implant failure or infection did not occur. Clinically, the Harris hip score was 98.9 (97~100) points.
CONCLUSION
Optimal open reduction and firm internal fixation with or without additional fixation was thought to be a recommendable method of treatment for comminuted subtrochanteric fractures of the femur caused by high energy trauma at a young age.

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Treatment of Subtrochanteric Femur Fractures Using Intramedullary Devices
Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Chong Suk Park, Sang Ho Lee
Journal of the Korean Fracture Society.2008; 21(1): 13. CrossRef

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Treatment of Subtrochanteric Fractures with Compression Hip Screw: Kee Haeng Lee, Hyoung Min Kim, Youn Soo Kim, Chang Hoon Jeong, Il Jung Park, Ill Seok Park, Chan Woong Moon; J Korean Fract Soc 2006;19(1):1-5. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.1

Abstract

PURPOSE
To evaluate the effectiveness of the compression hip screw, we reviewed the clinical results of cases of femoral subtrochanteric fracture which were treated with compression hip screw.
MATERIALS AND METHODS
From May 1997 to June 2004, 20 cases of femoral subtrochanteric fracture, which were treated with compression hip screw and followed up more than 12 months, were reviewed. By the Seinsheimer's classification, there were 1 case of type IIa, 4 cases of type IIb, 2 cases of type IIIa and IIIb, 4 cases of type IV and 7 cases of V. We analyzed the treatment results by bony union time, range of motion, ambulation status and complications.
RESULTS
All 20 cases were gained bony union without serious complications and secondary operation. The average bony union time was 19.8 weeks. 17 of 20 cases were recovered pre-injury ambulatory status level.
CONCLUSION
The compression hip screw may be effective in treatment of the femoral subtrochanteric fracture with very narrow intramedullary canal, proximal femoral deformity, comminuted fracture with large butterfly fragment, long spiral fracture with medial cortical comminution and combined intertrochanteric fracture.

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The stabilising effect by a novel cable cerclage configuration in long cephalomedullary nailing of subtrochanteric fractures with a posteromedial wedge
Pavel Mukherjee, Jan Egil Brattgjerd, Sanyalak Niratisairak, Jan Rune Nilssen, Knut Strømsøe, Harald Steen
Clinical Biomechanics.2019; 68: 1. CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef

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Treatment of subtrochanteric fracture - Comparison of treatment efficacy according to internal fixation device -: Taek Rim Yoon, Sung Man Rowe, Eun Kyoo Song, Jong Yoon Seol, Sang Gyoo Shin; J Korean Soc Fract 2001;14(2):189-199. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.189

Abstract PDF

PURPOSE
The purpose of this study was to compare the clinical results of subtrochanteric fractures which were treated with compression hip screw, intramedullary nailing and Rowe plate.
MATERIALS AND METHODS
From 1991 to 1999, 84 cases of subtrochanteric fractures were treated in Chonnam national university hospital. Among them, 25 cases were treated with compression hip screw, 18 cases with interlocking IM nailing and 32 cases with Rowe plate. Excluding pathologic fracture, there were 24 cases(group A), 16 cases(group B) and 30 cases(group C) of subtrochanteric fractures which were followed over 1 year. Mean follow up period was 18, 21, 24 months each. We compared the fracture pattern, operation time, operation method, additional fixation, bone union and complications among the groups.
RESULTS
We devided subtrochanteric fracture into below class II and above class III based on Seinsheimer classification. The overall clinical results were 1 case below class II, 22 above III in group A, 12 below II, 6 above II in group B, and 4 below II, 26 above III in group C. The average operation time was 153 minutes in group A, 166 in group B, and 150 in group C. Additional wiring was performed in 15 cases in group A, 1 in group B and 6 in group C. Interfragmentary screw fixation was performed only in group A(12 cases). Bone graft was performed in 6 cases in group A, 6 cases in group B and 11 cases in group C. The complications were as follows; delayed union 1 case in group A, 2 cases in group B and 6 cases in group C.; Nonunion only 1 case in group B; varus deformity 4 cases in group B and 2 cases in group C; metal failure 1 case in group B and 1 case in group C.
CONCLUSIONS
In treatment of subtrochanteric fractures, compression hip screw was applied to more communited fractures than intramedullary nail, but with additional fixation safe union and excellent clinical outcomes obtained. For intramedullary nailing, great care should be taken not to produce varus malalignment. In plate fixation, we should keep in mind the possibility of metal failure and varus malalignment. Weight bearing should be delayed.

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Extra-capsular proximal femoral fractures: a cohort comparison of union and complication rates after ballistic versus blunt trauma
Jordan Cook Serotte, Kevin Chen, Julia Nascimben, Jason Strelzow
European Journal of Orthopaedic Surgery & Traumatology.2025;[Epub] CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef
Efficacy of Percutaneous Cerclage Wiring in Intramedullary Nailing of Subtrochanteric Femur Fracture - Technical Note -
Ki-Chul Park, Hee-Soo Kim
Journal of the Korean Fracture Society.2013; 26(3): 212. CrossRef
The Treatment of Subtrochanteric Fracture with Cephallomedually Nail -Minimal Incision and Lowman Clamp Assisted Reduction-
Jang Seok Choi, Do Hyun Moon, Young Tae Noh
Journal of the Korean Fracture Society.2011; 24(4): 301. CrossRef

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Treatment of Comminuted Subtrochanteric Fractures of the Femur with Compression Hip Screw: You Sung Suh, Suk Bum Lim, Hyung Suk Choi, Yon Il Kim, Soo Kyoon Rah, Byung Ill Lee; J Korean Soc Fract 2001;14(2):181-188. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.181

Abstract PDF: PURPOSE
This study was performed to analyze the weight-bearing ambulation time, bony union time and complications after fixation of comminuted subtrochanteric fractures of the femur with compression hip screw and evaluate its effectiveness. MATERIAL & METHODS: From January 1993 to January 2000, 21 cases of S e i n s h e i m e r's Type IV and Type V comminuted subtrochanteric fractures of femur which were treated by compression hip screw and followed for more than 1 year were analyzed by weight-bearing ambulation time, bony union time and complications.
RESULTS
We recommended partial weight bearing ambulation from 6 weeks after operation and full weight bearing ambulation from 12 weeks after operation. All of 21 cases, primary bony union was achieved and mean time was 16 weeks(range 13 to 25 weeks). 2 cases of mechanical complications were occurred. Also 4 cases of malunion of lesser trochanter and 2 cases of nonunion of lesser trochanter were occurred, but none of them result in limitation of motion, limping nor pain.
CONCLUSIONS
We thought compression hip screw is a good implant for rigid fixation of comminuted subtrochanteric fractures, especially involve intertrochanteric region like Seinsheimer's Type IV and Type V.

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Surgical Treatment of Subtrochanteric Fracture with Compression Hip Screw: Taek Rim Yoon, Sung Man Rowe, Keun Bae Lee, Jae Il Oh; J Korean Soc Fract 2001;14(1):1-7. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.1

Abstract PDF: PURPOSE
The purpose of this study was to review the clinical results of 23 cases of subtrochanteric fractures which were treated with compression hip screw fixation and evaluation of the advantage of lateral position.
MATERIALS AND METHODS
From December 1993 to October 1999, 23 cases(l4 male, 9 female) of subtrochanteric fractures were treated with open reduction and internal fixation using compression hip screw. The mean age was 51.3 years(range, 18-89 years). All operations were done on the standard surgical table in lateral position, and additional fixation was done by supplementary screw fixation or cerclage wiring in 19 cases.
RESULTS
All patients (100%) went on to union on the average of 15 weeks (range l2-28 weeks). There were no complications, such as nonunion, malunion, or fixation loss. There was one delayed union which revealed radiographical bony union at postoperative 7 months.
CONCLUSION
Fixation with compression hip screw with or without additional fixation was thought to be a recommendable method of treatment for subtrochanteric fracture. The surgical procedure with the patient on lateral position enabled the surgeon to do interfragmentory fixation more safely and effectively with less disturbance of soft tissues attached to the fractured fragment.

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Osteopetrosis combined with Subtrochanteric Fracture of Femur: A Case Report: Ok Gyun An, Jong Ho Jang, Young Kyu Lim; J Korean Soc Fract 2000;13(4):804-808. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.804

Abstract PDF: Osteopetrosis (Albers-Schonberg's disease, Marble bones, and chalk bones) is a rare genetic disorder in which the bony structure throughout the body becomes dense and brittle. Because of the fragility of the pathologic bone, fractures are common and insufficient development of the bone marrow, optic atrophy, deafness, and facial paralysis can be developed to complications. We report a case of 35-year-old female with the autosomal dominant form of osteopetrosis combined with subtrochanteric fracture of femur that underwent surgical treatment.

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Subtrochanteric Fracture in Osteopetrosis: Yerl Bo Sung, Kook Jin Chung, Sung Wook Won, Jin Ho Kim, Hyung Jin Chung, Jae Kwang Hwang, Jae Kwang Yum, Jong Guk Ahn; J Korean Soc Fract 2000;13(3):440-444. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.440

Abstract PDF: Osteopetrosis is a rare inheritable skeletal disorder caused by a defective remodeling mechanism. The resultant bone of these children is dense, brittle and susceptible to fracture. We report a case of the subtrochanteric fracutre in osteopetrosis.

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The Operative Treatment of Subtrochanteric Fractures of the Femur: Sang Won Park, Young Soo Byun, Dang Jae Lim; J Korean Soc Fract 1999;12(4):818-823. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.818

Abstract PDF: PURPOSE
: The authort have investigated the subtrochanteric fractures, which were treated operatively using variable internal fixation devices to determine the clinical results according to the fracture types and internal fixation devices.
MATERIALS and METHODS
: We have reported 18 cases of subtrochanteric fractures, which were treated operatively using variable internal fixation devices from October, 1992 to December, 1997. fourteen cases were male and 4 cases were female. Eight cases were type I, 5 cases were type II and 5 cases were type III by Fieldings classification. Of fixation devices, 13 cases were DHS, and 5 cases were interlocking intramedullary nail. The mean duration of follow up was 1 year and 6 months.
RESULTS
The mean duration of bony union was 20.3 weeks, and there was no significant difference between fracture types or between internal fixation devices. Of the 18 cases, 4 complications(22%) were occured ; delayed union(1 case), nonunion(1 case), and varus deformity(2 cases).
CONCLUSION
: The internal fixation devices should be chosen adequately according to the fracture type in subtrochanteric fracture of the femur. Also, additional bone graft was necessary for posteromedial cortical defect to decrease complications, in cases of nail-plate devices especially.

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Surgical Treatment of Subtrochanteric Fracture of Femur with Spiral Blade Unreamed Intramedullary Femoral Nail: In Heon Park, Kyung Won Song, Seong Il Sin, Jin Young Lee, Keon Hyung Lee; J Korean Soc Fract 1999;12(2):239-244. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.239

Abstract PDF: The treatment of the subtrochanteric fracture is technically very demanding, independent of the implant material used and presents a challenge in terms of surgical management. A multitude of implants based on very different biomechanical and operative concept are employed to deal with the special conditions relating to these fractuers. The purpose of this study was to analyze the results of the surgical treatment of subtrochanteric fracture using spiral blade unreamed intramedullary femoral nail. Spiral blade unreamed intramedullary nails were applied in 9 subtrochanteric fractures. Fracture healing was uneventful and implant complications or loss of reduction were not observed. In conclusion, spiral blade unreamed intramedullary nail will be a a valuable addition to the fixation techniques available for the treatment of subtrochanteric femoral fractures.

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The Gamma Mail for Subtrochanteric Fractures of the Femur: Suk Kang, Jung Soo Hwang, Phil Hyun Chung, Dong Ju Chae, Yong Bum Park, Han Chul Kim, Kyu Hwang Um, Jeong Yong Hong; J Korean Soc Fract 1998;11(1):159-167. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.159

Abstract PDF: The aubtrochanteric area is cortical bone which has a decreased blood supply and a serious communition after trauma. Large biomechanical stresses in the subtrochanteric area can lead to failure of fixation devices. Many fixation devices have been used to treat the fractures of subtochanter of the femur. The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-shearing femoral component. We reviewed 15 patients of subtrochanteric fractures who were treated by use of the Gamma nail at Dongguk university hospital since March 1993. Results showed satisfactory fracture union with little loss of position, even in comminuted fractures. The patients had shorter convalescence and earlier weight bearing. Perioperative complications were few. We conclude that Gamma nail is effective in achieving good stabilization of the unstable fractures of the subtrochanteric region and is an advance in the treatment of subtrochanteric fractures of the femur.

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Treatment of Subtochanteric Fractures of the Femur by Interlocking Nailing: Do Hyun Moon, Bum Gu Lee, Jin Hong Ko, Young Kab Shin; J Korean Soc Fract 1997;10(3):548-555. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.548

Abstract PDF: Subtrochanteric fracture of the femur are difficult to treat successfully. Although performing operative treatment, the incidence of mechanical complication is higher than other sites of long bones. During the period of January. 1990 to June. 1995, twe nty-four cases of subtrochanteric fracture of femur were treated by Interlocking intramedullary nail at the Department of Orthopedic Surgery, Gil Hospital, Incheon, and the results were obtained as follows : 1. Associated injuries, which were common in lower limb(7 cases), pelvic bone(3 cases) and upper limb(4 cases) made a fracture more difficult to treat. 2. Fieldings type III(12 cases) fracture and Seinsheimers type II(18 cases) fracture and Russel-T aylors Type I A(19 cases) fracture and Winqist-Hansen Type II(13 cases) fracture were most common. 3. The average union time was 19.3 weeks. 4. The complications were three cases. : delayed union(1 case), infection(1 cases), angular deformity(1 case). 5. Interlocking nail is one of the good implant for rigid fixation of subtrochanteric fracture, especially mechanical characteristics of interlocking nail have eliminated the requirement of surgically reconstituting the medial femoral cortex.

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Operative Treatment of Subtrochonteric Fractures of the Femur: Sang Ho Ha, Sang Hong Lee, Young Bae Pyo, Yong Hyun Jeon; J Korean Soc Fract 1995;8(3):513-520. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.513

Abstract PDF

The reduction and maintenance of subtrochanteric fractures are difficult because most of these fractures are comminuted due to high velocity trauma. Although various devices of internal fixation have been developed to solve these problems, selecting the appropriate fixation device for different fracture types is difficult. Subtrochanteric fractures were treated operatively and analysed at Chosun University hospital from Jan.1985 to Dec.1991 and the following results were obtained. The most common type of fracture was type II a by Seinsheimer classification(11 cases,28.9%) The bone union rate was 81.8% in plate fixation group and 87.5% in intramedullary group. Of the 38 cases, 9 complications occured. From this study, it was concluded that intramedullary nailing is beneficial in subtrochanteric fractures associated with medial cortical comminution. Also, when plating was performed massive bone grafting & external support were required.

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On the role of the pre-ionization mechanism in the optical breakdown of molecular oxygen induced by CO2 laser: Numerical investigation
Yosr E. E.-D. Gamal, O. Aied Nassef, A. S. Salama
Physics of Plasmas.2019;[Epub] CrossRef

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Bilateral Subtrochanteric fracture After Pin Removal in Slipped Capital Femoral Epiphysis: A Case Report: Sung Joon Kim, Il Young Choi, Tai Seung Kim, Chung Kyu Choi; J Korean Soc Fract 1995;8(1):68-71. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.68

Abstract PDF: Subtrochanteric fracture of the femur has been infrequently reported after pin removal that is second operation for slipped capital femoral epiphysis and that fracture is a serious complication. We report a case of subtrochanteric fracture of the femur occured after pin removal that had been inserted for fixation of slipped capital femoral epiphysis. Its treatment was open reduction with condylar blade plate and screws. We recommend insertion of fewer pins and longer pins at higher level, early pin removal, avoidance of repeated insertion and use of cannulated pin screw instead of Knowles pin for prevention of subtrochanteric fracture after pin removal.

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