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Original Article
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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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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Technical Note
Operative Positioning Technique for an Intertrochanteric Fracture in a Patient with an Ipsilateral Above-the-Knee Amputation - Technical Note -
Dae-Hyun Park, Yong-Uk Kwon, Dong-Seok Kim
J Korean Fract Soc 2021;34(4):137-141.   Published online October 31, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.4.137
AbstractAbstract PDF
A 45-year-old man with a remote history of a left above-the-knee amputation presented to the emergency department with left hip pain after a mechanical fall. This case was an operative challenge because commonly used intraoperative traction methods could not be applied to a patient with an above-the-knee amputation. We describe a rarely utilized surgical technique of applying traction to an amputated extremity via a Steinmann pin during closed reduction and internal fixation of an intertrochanteric fracture.

Citations

Citations to this article as recorded by  
  • Periprosthetic Femur Fractures in Osseointegration Amputees
    Jason Shih Hoellwarth, S. Robert Rozbruch
    JBJS Case Connector.2022;[Epub]     CrossRef
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Case Report
Helical Blade Locking Sleeve Disassembly Following Failed Femur Intertrochanter Fracture
Soon Ho Huh, Hong-Man Cho, Ji-Yeon Park
J Korean Fract Soc 2021;34(3):112-116.   Published online July 31, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.3.112
AbstractAbstract PDF
A helical blade type of hip screw is used widely for the operative management of femoral trochanteric fractures. A 73-year-old female patient was admitted for femoral trochanteric fracture AO/OTA type 31A2.2. A helical blade locking sleeve dissembled 18 weeks after surgery did not achieve accurate reduction. The patient underwent bipolar hip hemiarthroplasty because the fracture reduction was lost, and it was impossible to remove the remaining helical blade without bone loss. The authors report this case of a rare complication of helical blade.
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Original Articles
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
J Korean Fract Soc 2021;34(3):105-111.   Published online July 31, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.3.105
AbstractAbstract PDF
Purpose
This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation NailAdvanced; Depuy Synthes) for the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated.
Results
Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases.
Conclusion
TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.

Citations

Citations to this article as recorded by  
  • 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
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Comparison of Reductions of Left and Right Proximal Portions of Intertrochanteric Fractures Treated by Intramedullary Nailing
Hyun Cheol Oh, Joong Won Ha, Yung Park, Sang Hoon Park, Han Kook Yoon
J Korean Fract Soc 2021;34(2):64-70.   Published online April 30, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.2.64
AbstractAbstract PDF
Purpose
This study examined the effect of lag screw insertion on proximal fragments by separating the right and left sides of intertrochanteric fractures in elderly patients that underwent intramedullary nailing.
Materials and Methods
Patients aged ≥65 years that underwent intramedullary nailing after a diag-nosis of intertrochanteric fractures during the period February 2012 to May 2016 were included in the study. The subjects were divided into right and left side groups. The effect of the clockwise rotational force generated when a lag screw was inserted on the proximal fragment was evaluated in both groups.
Results
In the right and left groups, most proximal fragments were located in the intramedullary canal after surgery (45 cases [75.0%] and 67 cases [73.6%], respectively). Clockwise rotation due to lag screw placement in the right group occurred in two cases (3.3%), which both showed internal rotation, and in four cases (4.4%) in the left group, all of which showed external rotation.
Conclusion
After intramedullary nailing of intertrochanteric fractures in elderly patients, proximal fragments were mostly located in the intramedullary cavity. The results obtained confirmed that the clockwise rotational force generated by lag screw insertion did not affect left or right sides.

Citations

Citations to this article as recorded by  
  • Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?
    Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin
    European Journal of Trauma and Emergency Surgery.2025;[Epub]     CrossRef
  • Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results
    You-Sung Suh, Jae-Hwi Nho, Min Gon Song, Dong Woo Lee, Byung-Woong Jang
    Clinics in Orthopedic Surgery.2023; 15(3): 373.     CrossRef
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Comparison of the U-Blade Gamma3 Nail and the Zimmer Natural Nail for the Treatment of Intertrochanteric Fracture
Jae Sung Suh, Hyung-Gon Ryu, Young Ju Roh, Dae Won Shin, Sang-Min Kim
J Korean Fract Soc 2021;34(2):57-63.   Published online April 30, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.2.57
AbstractAbstract PDF
Purpose
This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN).
Materials and Methods
The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared.
Results
Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted.
Conclusion
No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.
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Case Report
Rendezvous Surgery for Peri-Implant Fractures around Locking Compression Plate on Anterolateral Bowed Femur - A Case Report -
Hong Man Cho, Jiyeon Park
J Korean Fract Soc 2020;33(3):159-163.   Published online July 31, 2020
DOI: https://doi.org/10.12671/jkfs.2020.33.3.159
AbstractAbstract PDF
An 84-year-old female visited with an intertrochanteric femoral fracture. The patient had undergone an open reduction and internal fixation with a compressive plate and elastic nail in an ipsilateral atypical diaphyseal femoral fracture in the past. Compressive plate and elastic nail remained, and anterolateral bowing was presented. To treat the periprosthetic trochanteric fracture, a proximal femoral nail was used without removing the previously inserted compressive plate. Under the “rendezvous” technique, using a combination of fixating intramedullary nail and compressive plate simultaneously, the distal screw was fixed, and a femoral head lag screw was inserted after reducing the fracture. Complete union of the fracture was achieved 16 months after the operation, and a decrease in mobility function was not found postoperatively. The authors report this case for the “rendezvous” technique as a treatment option for elderly patients with periprosthetic trochanteric fractures, who had previously undergone surgical treatment for ipsilateral atypical diaphyseal femoral fractures with anterolateral bowing.
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Original Article
Clinical and Radiological Outcomes of Polished Cemented Bipolar Hemiarthroplasty for Intertrochanteric Fractures in Elderly Patients
Suc-Hyun Kweon, Chang-Hyun Shin, Yeong-Chang Lee, Min-Woo Kim, Tae-Ho Kim
J Korean Fract Soc 2020;33(3):134-141.   Published online July 31, 2020
DOI: https://doi.org/10.12671/jkfs.2020.33.3.134
AbstractAbstract PDF
Purpose
To evaluate the clinical and radiological outcomes of bipolar hemiarthroplasty using a polished cemented femoral stem for intertrochanteric fractures in elderly patients.
Materials and Methods
From July 2005 to May 2015, 48 patients diagnosed with intertrochanteric fractures underwent bipolar hemiarthroplasty. The mean age and follow-up period were 80.5 years and 30.5 months, respectively. The postoperative results were evaluated clinically and radiologically.
Results
The mean operation time was 100 minutes (range, 90-120 minutes), and the mean amount of blood loss was 334 ml (range, 170-500 ml). At the last follow-up, the mean Harris hip score (HHS), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 82.2 (range, 76-90), 0.8 (range, 1-3), and 36 (range, 30-40), respectively. Walking was initiated using a walker for partial weight-bearing, and the mean walking time was 5.8 days (range, 3-14 days). Ambulatory ability was restored to a walking state before the injury in 36 cases (75.0%), and wheelchair ambulation was possible in 12 cases (25.0%). The instrumental activities of daily living (IADLs) were 17 patients (35.4%), and the basic activities of daily living (BADLs) were 31 patients (64.6%).
Conclusion
Polished cemented bipolar hemiarthroplasty can achieve secure fixation with no postoperative thigh pain. Restoring the preoperative walking ability will be more helpful for intertrochanteric fractures in elderly patients.
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Case Report
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
AbstractAbstract 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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Original Article
The Effects of Extramedullary Reduction in Unstable Intertrochanteric Fracture: A Biomechanical Study Using Cadaver Bone
Young Chang Park, Soon Phil Yoon, Kyu Hyun Yang
J Korean Fract Soc 2018;31(3):79-86.   Published online July 31, 2018
DOI: https://doi.org/10.12671/jkfs.2018.31.3.79
AbstractAbstract PDF
PURPOSE
To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2).
MATERIALS AND METHODS
Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified.
RESULTS
The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens.
CONCLUSION
In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.

Citations

Citations to this article as recorded by  
  • Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?
    Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin
    European Journal of Trauma and Emergency Surgery.2025;[Epub]     CrossRef
  • The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures: A multicenter randomized controlled trial
    Takashi Maehara, Takashi Hayakawa, Shunsuke Mukoyama, Yoshihisa Anraku, Takahiro Hamada, Hiroyuki Suzuki, Takeshi Doi, Tomohiko Shimizu, Masanori Yorimitsu, Hidefumi Teramoto, Takao Mae, Yasunori Okamoto, Jun Hara, Kazushi Mihara, Koichi Kanekasu
    Injury.2024; 55(10): 111725.     CrossRef
  • Anteromedial cortical support reduction of intertrochanteric fractures–A review
    Wenjun Xie, Liu Shi, Cheng Zhang, Xueliang Cui, Xiangxu Chen, Tian Xie, Sheng Zhang, Hui Chen, Yunfeng Rui
    Injury.2024; 55(12): 111926.     CrossRef
  • Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures
    Wei Mao, Chen-Dong Liu, Shi-Min Chang, Ao-Lei Yang, Choon Chiet Hong
    Journal of Bone and Joint Surgery.2024; 106(11): 1008.     CrossRef
  • Five states of reduction in OTA/AO A1.3 intertrochanteric fractures of the femur a biomechanical study
    Shu Li, Yong-Gang Bao, Rong-Hua Tian, Chun-Yang Meng, Hai-Bin Wang, Bin Wu, Xian-Min Bu
    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
  • Intramedullary Impaction of the Basicervical Component is Determinant of Fixation Failure in a Simple Two-Part Pertrochanteric Fracture
    Seok Ha Hong, Kang Hun Yu, Seung Beom Han
    Journal of Orthopaedic Trauma.2024;[Epub]     CrossRef
  • Flexible reamer use to overcome entry point errors in proximal femoral nail application in severe obese intertrochanteric fracture patients
    Levent Horoz, Ali Ihsan Kilic, Cihan Kircil, Mehmet Fevzi Cakmak
    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
  • Risk Factors Associated with Fixation Failure in Intertrochanteric Fracture Treated with Cephalomedullary Nail
    Hyung-Gon Ryu, Dae Won Shin, Beom Su Han, Sang-Min Kim
    Hip & Pelvis.2023; 35(3): 193.     CrossRef
  • Positive or negative anteromedial cortical support of unstable pertrochanteric femoral fractures: A finite element analysis study
    Qin Shao, Yue Zhang, Gui-Xin Sun, Chen-Song Yang, Na Liu, Da-Wei Chen, Biao Cheng
    Biomedicine & Pharmacotherapy.2021; 138: 111473.     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
  • Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation
    Oog-Jin Shon, Chang Hyun Choi, Chan Ho Park
    Hip & Pelvis.2021; 33(3): 154.     CrossRef
  • Additional Reduction Screw Fixation Technique for Pertrochanteric Hip Fractures: A Novel Method to Prevent Excessive Sliding in Cephalomedullary Nail Surgery
    Chul-Ho Kim, Han Soul Kim, Dou Hyun Moon
    Hip & Pelvis.2021; 33(3): 162.     CrossRef
  • Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: A systematic review and meta-analysis
    Eic Ju Lim, Seungyeob Sakong, Whee Sung Son, Jae-Woo Cho, Jong-Keon Oh, Chul-Ho Kim
    Injury.2021; 52(10): 2787.     CrossRef
  • A new fluoroscopic view for evaluation of anteromedial cortex reduction quality during cephalomedullary nailing for intertrochanteric femur fractures: the 30° oblique tangential projection
    Shi-Yi Chen, Shi-Min Chang, Rujan Tuladhar, Zhen Wei, Wen-Feng Xiong, Sun-Jun Hu, Shou-Chao Du
    BMC Musculoskeletal Disorders.2020;[Epub]     CrossRef
  • New Approach in the Treatment of Intertrochanteric Fracture Using a Cephalomedullary Nail
    Junyoung Kim, Kihong Choi, Kyu Hyun Yang
    Journal of the Korean Orthopaedic Association.2020; 55(3): 193.     CrossRef
  • Effect of a synthetic osteoconductive bone graft substitute with zeta potential control (geneX®ds) in the treatment of intertrochanteric fracture: A single center experience of 115 consecutive proximal femoral nail antirotations
    Won Chul Shin, Jae Hoon Jang, Jae Yoon Jeong, Kuen Tak Suh, Nam Hoon Moon
    Journal of Orthopaedic Science.2019; 24(5): 842.     CrossRef
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Case Report
Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing: A Case Report
Jung Woo Lee, Hong Man Cho, Jae Woong Seo
J Korean Fract Soc 2017;30(4):203-208.   Published online October 31, 2017
DOI: https://doi.org/10.12671/jkfs.2017.30.4.203
AbstractAbstract PDF
Hip fractures are common among elderly individuals. Internal fixation with the intramedullary system has been widely used to treat intertrochanteric femur fractures. The Gamma 3 nail is a useful device for fixating trochanteric fractures of the proximal femur. We report a rare complication of medial pelvic penetration of the lag screw of a Gamma 3 nail two months after surgery. There was a complete separation between the nail body and lag screw, and the lag screw penetrated through the acetabulum into the pelvis. We report a case of unstable intertrochanteric fracture with intrapelvic penetration after surgical treatment with proximal femoral nailing and a case followed by fatal results.

Citations

Citations to this article as recorded by  
  • Medial lag screw migration in an intramedullary nail combination
    Zac Dragan, Ryan J Campbell, Terence R Moopanar
    BMJ Case Reports.2025; 18(3): e262436.     CrossRef
  • Endovascular assisted removal of intrapelvic lag screw after intramedullary proximal femoral nail: A case report and literature review
    Zakaria Mousati, Mathias Van Den Broek, Joren Callaert, Jan Gielis, Kris Govaers
    Trauma Case Reports.2023; 46: 100873.     CrossRef
  • Intrapelvic migration of the lag screw in intramedullary nailing after intertrochanteric fracture fixation: A case report
    Aymen Ben Fredj, Hedi Rbai, Fourat Farhat, Marouen Berriri
    Clinical Case Reports.2022;[Epub]     CrossRef
  • Intramedullary nailing confers an increased risk of medial migration compared to dynamic hip screw fixation in unstable intertrochanteric hip fractures
    Gin Way LAW, Yoke Rung WONG, Antony GARDNER, Yau Hong NG
    Injury.2021; 52(11): 3440.     CrossRef
  • Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures
    G. W. Law, Y. R. Wong, A. K-S. Yew, A. C. T. Choh, J. S. B. Koh, T. S. Howe
    Bone & Joint Research.2019; 8(7): 313.     CrossRef
  • Intrapelvic Migration of the Lag Screw with Wedge Wing from Dyna Locking Trochanteric Nail: A Case Report and Literature Review
    Yong-Woo Kim, Weon-Yoo Kim, Kyong-Jun Kim, Se-Won Lee
    Hip & Pelvis.2019; 31(2): 110.     CrossRef
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Original Articles
Comparison of the Treatment Results between Reduction with Percutaneous Wiring and Reduction without Percutaneous Wiring in Reverse Oblique Trochanteric Fractures (AO Classification 31-A3.3)
Jae Woo Park, Oog Jin Shon, Seung Wan Lim
J Korean Fract Soc 2017;30(4):192-197.   Published online October 31, 2017
DOI: https://doi.org/10.12671/jkfs.2017.30.4.192
AbstractAbstract PDF
PURPOSE
The aim of this study was to investigate the utility of percutaneous wiring in the reduction of reverse oblique trochanteric fractures (AO classification 31-A3.3) by analyzing the treatment results with or without the use of percutaneous wiring.
MATERIALS AND METHODS
Thirty-five cases from January 2008 to August 2014 that could be followed-up for at least one year were selected among patients with unstable trochanteric fractures who underwent either internal fixation or open reduction. Seventeen patients underwent surgery with percutaneous wire fixation but another 18 patients underwent surgery without it. All patients received a closed reduction and internal fixation with an intramedullary nail. The factors evaluated were as follows: the length of operation, loss of blood, length of in-hospital stay, lower limb function scale, return to preinjury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, time taken for bone attachment, quality of post-operative reduction, and complications.
RESULTS
No significant difference in the mean operative time, loss of blood, length of in hospital stay, lower limb function scale, return to pre-injury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, and quality of postoperative reduction was observed between the two groups. A significant difference was noted in the time taken for bone attachment (p=0.032). Bone attachment took 13.3 weeks (9–17 weeks) on average when fixed with percutaneous wiring and no patient was found to have any complications. When treated without percutaneous wiring, however, bone attachment took 17.8 weeks (12.5–28.0 weeks) on average and three cases resulted in delayed union.
CONCLUSION
Percutaneous wiring is a recommended treatment option for patients with an unstable trochanteric fracture.
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The Determination of Optimal Entry Point for Proximal Femoral Nail Antirotation-II by Fluoroscopic Simulation: A Cadaveric Study
Jin Hoon Jeong, Gu Hee Jung
J Korean Fract Soc 2017;30(4):173-179.   Published online October 31, 2017
DOI: https://doi.org/10.12671/jkfs.2017.30.4.173
AbstractAbstract PDF
PURPOSE
This study seeks to determine the anatomically optimal entry point of proximal femoral nail antirotation-II (PFNA-II®) according to geographic features of Korean cadaveric femoral trochanters for successful reduction of osteoporotic proximal femoral fractures.
MATERIALS AND METHODS
Forty-three adult cadaveric femurs without previous fractures or surgeries were included. Anteroposterior (AP) and lateral images of all femurs and PFNA-II® were taken with an image intensifier. Using the image synthesis process via the image editing program (Adobe Photoshop CS6), the optimal entry point was verified and compared with the tip of the greater trochanter (GT) and the cervicotro-chanteric junction on AP images, as well as the width of the trochanter and the neck on lateral images.
RESULTS
The optimal entry point of PFNA-II® was an average distance of 9.1 mm (range, 7–15 mm) medially from the tip of GT on AP images. The center of the nail was located at an average of 30% (range, 21%–44%) area from the posterior margin of the middle neck, which is an average area of 38% (range, 26%–48%) from the posterior cortex of the trochanter on lateral images. Furthermore, the ideal entry point was at the extended line of the cervico-trochanteric junction.
CONCLUSION
The optimal entry point, which was found to be medial to the tip of the GT and posterior to the center of the middle femoral neck and the trochanter, was at on the extended line of the cervicotrochanteric junction.

Citations

Citations to this article as recorded by  
  • Clinical Research through Computational Anatomy and Virtual Fixation
    Ju Yeong Kim, Dong-Geun Kang, Gu-Hee Jung
    Journal of the Korean Orthopaedic Association.2023; 58(4): 299.     CrossRef
  • Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study
    Chittawee Jiamton, Nonpawit Nimmankiatkul, Pongsakorn Rungchamrassopa, Wichan Kanchanatawan, Pariyut Chiarapatanakom, Wirat Kongcharoensombat
    Journal of Southeast Asian Orthopaedics.2022;[Epub]     CrossRef
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Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients
Kyung Hoon Lee, Suk Ku Han, Seung Jae Chung, Jongho Noh, Kee Haeng Lee
J Korean Fract Soc 2016;29(3):192-199.   Published online July 31, 2016
DOI: https://doi.org/10.12671/jkfs.2016.29.3.192
AbstractAbstract PDF
PURPOSE
The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate.
MATERIALS AND METHODS
From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done.
RESULTS
The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications.
CONCLUSION
Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.
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A Comparative Study of TRIGENâ„¢ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures
Jae Hoon Jang, Jeung Il Kim, Um Ji Kim, Nam Hoon Moon
J Korean Fract Soc 2016;29(2):128-136.   Published online April 30, 2016
DOI: https://doi.org/10.12671/jkfs.2016.29.2.128
AbstractAbstract PDF
PURPOSE
The primary purpose of this study was to demonstrate that the TRIGENâ„¢ INTERTAN nail (InterTAN) could show better clinical outcome compared to the proximal femoral nail antirotation 2 (PFNA2) for treatment of intertrochanteric fracture in the elderly.
MATERIALS AND METHODS
Between March 2009 and December 2013, 164 patients with intertrochanteric fractures who met our inclusion and exclusion criteria were enrolled in this study. Evaluation variables, including operation time, blood loss during the operation, incidence of perioperative complications, clinical results at the last follow-up, and radiographic findings were assessed for comparison of the 2 implants.
RESULTS
Intraoperative lateral wall fracture was significantly higher in the PFNA2 group (p<0.05) and tip apex distance was significantly higher in the InterTAN group (p<0.05). Sliding of the proximal fragment at the last follow-up was significantly higher in the PFNA2 group. However, there was no significant difference in union rate, time to union, postoperative complications, and clinical outcomes at the last follow-up between the 2 groups.
CONCLUSION
Based on these data, clinical outcomes at the last follow-up were equivalent between InterTAN and PFNA2.

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  • Unstable Intertrochanteric Fracture: Do We Know Everything? A Review
    Balaji Zacharia, Harshitha Hayavadana Udupa
    SN Comprehensive Clinical Medicine.2022;[Epub]     CrossRef
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Analysis of Low-Energy Trochanter Fracture Using the Multiplanar Computed Tomography Image: Application for Intramedullary Nail Fixation
Gu Hee Jung, Sung Keun Heo, Hyun Je Seo
J Korean Fract Soc 2015;28(3):155-162.   Published online July 31, 2015
DOI: https://doi.org/10.12671/jkfs.2015.28.3.155
AbstractAbstract PDF
PURPOSE
The purpose of this radiologic study was to evaluate the geographic patterns of low-energy trochanteric fractures using multiplanar computed tomography (CT) images for application of intramedullary nailing.
MATERIALS AND METHODS
In this study, 117 trochanteric fractures (stable fracture, 39 cases, unstable fractures, 78 cases) sustained from simple slip-down were assessed. The mean age was 78.4 years (range, 60-96 years). Multiplanar CT images were assessed for evaluation of geographic features of trochanteric fracture, and the fracture exit and geographic patterns were analyzed.
RESULTS
The medial and lateral exit of the trochanteric fracture showed no statistical difference by age, bone density, and comorbid disease. The exit was located at an average distance of 10.2 mm (range, 1.0-22.2 mm) from the tip of the greater trochanter (GT), and the medial exit, average distance of 8.1 mm (range, 0.0-18.3 mm) from the tip of the lesser trochanter. It was also found that there was no comminution around the anteromedial cortex of the fracture, and its contact loss was from fracture deformity.
CONCLUSION
Because of no comminution, the contact restoration of the anteromedial cortex resulted in correction of fracture deformity and reduction. Trochanteric nailing by GT tip could be fixed through the proximal fragment of the fracture because the lateral exit is placed at an average distance of 10.2 mm from the GT tip.
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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
AbstractAbstract 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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Perioperative Blood Loss in Intramedullary Hip Screw for Intertrochanteric Fracture: Analysis of Risk Factors
Jai Hyung Park, Hwa Jae Jung, Hun Kyu Shin, Eugene Kim, Se Jin Park, Taeg Su Ko, Jong Hyon Park
J Korean Fract Soc 2015;28(1):53-58.   Published online January 31, 2015
DOI: https://doi.org/10.12671/jkfs.2015.28.1.53
AbstractAbstract PDF
PURPOSE
We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors.
MATERIALS AND METHODS
A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents.
RESULTS
Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference.
CONCLUSION
Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.
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Case Report
Removal Methods for Broken Proximal Femoral Nails Using Ball Tip Guide Wire: Technical Note and Two Cases Report
Bong Ju Park, Hong Man Cho
J Korean Fract Soc 2014;27(4):315-320.   Published online October 31, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.4.315
AbstractAbstract PDF
Recently, the use of intramedullary nailing for proximal femoral fractures has increased. Breakage of the nail usually occurs at the un-united fracture site, and it is a rare complication of intramedullary nailing of the femur. However, removal of the distal fragment of a broken nail is a challenging problem. Herein, the authors describe the methods used for removal of relatively fixed or strongly fixed broken intramedullary nails in two different cases.

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  • Breakage of the Tail Portion of the Lag Screw during Removal of Proximal Femoral Zimmer Natural Nail: Report of Two Cases with Technical Notes
    Asep Santoso, Ik-Sun Choi, Kyung-Soon Park, Taek-Rim Yoon
    Hip & Pelvis.2017; 29(3): 199.     CrossRef
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Original Articles
Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures
Bing Zhe Huang, Yong Wook Park, Jin Su Park, Kyu Cheol Noh, Soung Yon Kim, Kook Jin Chung, Hong Kyun Kim, Hyong Nyun Kim, Yong Hyun Yoon, Ji Hyo Hwang
J Korean Fract Soc 2014;27(3):213-221.   Published online July 31, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.3.213
AbstractAbstract PDF
PURPOSE
This study was conducted in order to demonstrate the radiologic and clinical results of using the Asian type gamma 3 nail in treatment of trochanteric fractures.
MATERIALS AND METHODS
Patients underwent operations with gamma 3 nails between August 2010 and August 2012. For the radiologic evaluation, we analyzed bone quality, fracture pattern, reduction quality, union period, and position of lag screw (tip-apex distance, Cleveland index). For the clinical evaluation, we analyzed mobility score of Palmer and Parker and Jensen's functional score.
RESULTS
The mean union was taken at 17.4 weeks (14-25 weeks). Two cases (4.3%) underwent reoperation due to cutting out of the hip screws. The clinical outcomes of Parker and Palmer's average mobility score changed from 7.3 to 5.8 (79%), Jensen's functional score was 1.3 to 1.8 (72%).
CONCLUSION
We achieved excellent clinical and radiological outcomes; therefore, Asian type gamma 3 nail is effective in treatment of trochanteric fractures of the femur in Korea.

Citations

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  • Clinical and radiological outcome of the Chimaera short nailing system in inter- and subtrochanteric fractures
    Aurélien Traverso, Trieu-Hoai-Nam Ngo, Guillem Fernandez Gil, Xavier Lannes, Sylvain Steinmetz, Kevin Moerenhout
    Injury.2023; 54(3): 970.     CrossRef
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Results of Use of Compression Hip Screw with Trochanter Stabilizing Plate for Reverse Oblique Intertrochanteric Fracture
Byung Woo Min, Kyung Jae Lee, Gyo Wook Kim, Ki Cheor Bae, Si Wook Lee, Du Han Kim
J Korean Fract Soc 2014;27(2):120-126.   Published online April 30, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.2.120
AbstractAbstract PDF
PURPOSE
The aim of this study was to analyze the use of a compression hip screw with a trochanter stabilizing plate for treatment of reverse oblique intertrochanteric fractures.
MATERIALS AND METHODS
We reviewed the results of 33 cases of reverse oblique intertrochanteric fracture treated with a compression hip screw with a trochanter stabilizing plate from January 2000 to December 2012 which were followed-up for more than one year. We evaluated postoperative bone union period, change of neck-shaft angle, sliding of hip screw, and other complications.
RESULTS
Of 33 patients, satisfactory reduction was achieved in 28 patients. Five patients had an unsatisfactory reduction, with two cases of excessive screw sliding, one of broken metal, one of varus deformity, and one of internal rotation deformity. We performed corrective osteotomy in varus and internal rotation deformity and partial hip replacement in a case of excessive screw sliding. Bone union was achieved in 29 patients, and the average bone union period was 19.2 weeks.
CONCLUSION
We consider that a compression hip screw with a trochanteric stabilized plate is a good option for treatment of reverse oblique intertrochanteric femoral fractures. However, adequate fracture reduction and ideal implant placement are a basic necessity for successful treatment.
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Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture
Dong Hyeok Choi, Ju Yeong Heo, Young Jae Jang, Young Yool Chung
J Korean Fract Soc 2014;27(1):58-64.   Published online January 31, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.1.58
AbstractAbstract PDF
PURPOSE
We classified fractures of the greater trochanter (GT) and evaluated fracture fragment stability according to GT type.
MATERIALS AND METHODS
A total of 43 patients with an unstable intertrochanteric fracture treated between January 2007 and July 2009 with bipolar hemiarthroplasty were included in this study. GT fractures were classified as type A, B, C, or D and fixed using either cerclage wiring alone, cerclage wiring and non-absorbable suture or a greater trochanteric reattachment (GTR) plate.
RESULTS
Type A fractures were fixed using cerclage wiring with non-absorbable suture in two cases, cerclage wiring in six cases and GTR plate in seven cases. Failure occurred in three cases of type A fractures treated with cerclage wiring alone. A total of 11 type B fractures were fixed with cerclage wiring (7), cerclage wiring and non-absorbable suture (3) and GTR plate (1). There was no failure of type B fractures. Type C fractures were fixed using cerclage wiring with non-absorbable suture in one case and GTR plate in three. There was no fixation in three cases. Of 10 type D fractures, six were treated with cerclage wiring and one with GTR plate. Fixation was not performed in three patients. There was no failure in type C and D type fractures.
CONCLUSION
Fracture fragment stability differed according to fracture types. Cerclage wiring alone was insufficient to fix type A fractures, so type A fracture required a stronger fixation method.

Citations

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  • Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique
    Javahir A. Pachore, Vikram Indrajit Shah, Sachin Upadhyay, Shrikunj Babulal Patel
    Hip & Pelvis.2023; 35(2): 108.     CrossRef
  • The Efficacy of Suture Fixation of the Greater Trochanter in Unstable Intertrochanteric Fractures
    Ki-Choul Kim, Hee-Gon Park, Jae-Wook Park
    Clinics in Orthopedic Surgery.2021; 13(4): 468.     CrossRef
  • Is rigid fixation of the greater trochanter necessary for arthroplasty of intertrochanteric fractures?
    Kee Haeng Lee, Dong Hun Lee, Jong Ho Noh, Yoon Vin Kim
    Orthopaedics & Traumatology: Surgery & Research.2019; 105(1): 41.     CrossRef
  • Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures
    Min-Wook Kim, Young-Yool Chung, Sung-an Lim, Seung-Woo Shim
    Hip & Pelvis.2019; 31(3): 144.     CrossRef
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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
J Korean Fract Soc 2014;27(1):36-41.   Published online January 31, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.1.36
AbstractAbstract PDF
PURPOSE
To evaluate whether the radiological and clinical results of treatment with intertrochanteric/subtrochanteric (ITST) nail on unstable intertrochanteric fractures are combined with comminution of the greater trochanter or not.
MATERIALS AND METHODS
We reviewed the results on 210 cases of unstable intertrochanteric fractures (grouped 88 patients with comminution of greater trochanter [GT] and 122 patients without comminution of GT) treated with ITST nail from January 2007 to October 2011, which was to be followed-up for more than 12 months.
RESULTS
The mean union time was 15.2 weeks in the study group (combined with comminution of GT). The mean union time was 14.7 weeks in control group (no comminution of GT). The lag screw sliding was 8.7 mm in the study group and 7.2 mm in the control group. Changes of neck-shaft angle was 4.2degrees in study group and 4.1degrees in control group. Tip-apex distance was 17.4 mm in study group and 16.4 mm in control group. The complications were 4 cases in each study group and control group. The clinical results checked by Skovron recovery scores decreased similarly in both groups, 73.7% in study group and 76.5% in control group. There were no significant differences in both groups according to radiological and clinical results.
CONCLUSION
The comminution of great trochanter does not affect on the radiological and clinical results when using the ITST nail of unstable intertrochanteric fractures.
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Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures
Jee Hoon Kim, Oog Jin Shon
J Korean Fract Soc 2013;26(4):305-313.   Published online October 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.4.305
AbstractAbstract PDF
PURPOSE
To compare the results between Proximal femoral nail antirotation II (PFNA II) and Zimmer natural nail Asia type (ZNN) for the treatment of stable intertrochanteric fractures.
MATERIALS AND METHODS
Between September 2011 and September 2012, 40 consecutive patients with stable intertrochanteric femoral fractures were treated with PFNA II or ZNN. We reviewed 20 cases of PFNA II and 20 cases of ZNN prospectively. We evaluated the operation time, amount of bleeding, mean hospital day, and capability of mobility and function using 'mobility score of Parker and Palmer' and 'social score of Jensen'. We also evaluated the reduction state by the Fogagnolo, Cleveland index, change of tip and apex distance (TAD), sliding distance of cervical screw, change of neck shaft angle and bone union time.
RESULTS
There were no significant differences between the groups treated with PFNA and ZNN. Both groups showed good clinical results. PFNA showed less TAD change and ZNN showed a shorter sliding distance of cervical screw, but they were not statistically different. The bone union time was approximately 13 weeks in both groups.
CONCLUSION
PFNA and ZNN produced good clinical and radiologic results in the treatment of stable intertrochanteric fractures. There were no significant differences between the groups. Both implants provide good stability and union, so we can conclude that they are both suitable for the treatment of stable intertrochanteric fractures.

Citations

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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
    Journal of the Korean Fracture Society.2022; 35(4): 162.     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
  • Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail
    Woong Chae Na, Chae Won Lim, Sang Hong Lee
    Medical Biological Science and Engineering.2018; 1(2): 45.     CrossRef
  • BONE HEALING PATTERNS OF INTERLOCKED INTRAMEDULLARY NAIL-FIXATED FEMORAL SHAFT FRACTURES: AGE-MATCHED RADIOGRAPHIC PRESENTATION OF UNION PATTERN
    Myung-Sang Moon, Dong-Hyeon Kim, Bong-Keun Park, Min-Geun Yoon
    Journal of Musculoskeletal Research.2017; 20(02): 1750010.     CrossRef
  • The Curative Effect Comparison Between Prolonged Third Generation of Gamma Nail and Prolonged Dynamic Hip Screw Internal Fixation in Treating Femoral Intertrochanteric Fracture and the Effect on Infection
    Wenye He, Wei Zhang
    Cell Biochemistry and Biophysics.2015; 71(2): 695.     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
AbstractAbstract 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.

Citations

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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
AbstractAbstract 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.

Citations

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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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Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures
Se Ang Jang, Young Ho Cho, Young Soo Byun, Ki Hong Park, Hyun Seong Yoo, Chul Jung
J Korean Fract Soc 2013;26(3):199-204.   Published online July 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.3.199
AbstractAbstract PDF
PURPOSE
To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur.
MATERIALS AND METHODS
Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail.
RESULTS
The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery.
CONCLUSION
If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.

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  • PREOPERATIVE NUTRITIONAL STATUS OF HIP FRACTURE PATIENTS: A PILOT STUDY IN 116 PATIENTS
    Myung-Sang Moon, Min-Suk Park, Bong-Keun Park, Dong-Hyeon Kim, Min-Geun Yoon
    Journal of Musculoskeletal Research.2017; 20(01): 1750002.     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
AbstractAbstract 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.

Citations

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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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A Comparison between Compression Hip Screw and Intramedullary Nail for the Treatment of AO/OTA A2.2 Intertrochanteric Femoral Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Jong Hyun Kim
J Korean Fract Soc 2013;26(1):44-49.   Published online January 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.1.44
AbstractAbstract PDF
PURPOSE
To compare the result between the compression hip screw (CHS) and intramedullary (IM) nail for the treatment of AO/OTA A2.2 intertrochanteric fracture.
MATERIALS AND METHODS
We retrospectively reviewed 95 cases of AO/OTA A2.2 intertrochanteric fracture, which were treated with CHS or IM nail by one surgeon from March 1994 to December 2009. One group was treated with CHS (Group I, 28 cases) and the other was treated with IM nail (Group II, 67 cases). We evaluated the mean operation time, the amount of bleeding and transfusion, hospital duration, radiological results and the clinical outcome with the mobility score of Parker and Palmer.
RESULTS
Radiologically, the tip-apex distance, change of neck-shaft angle, and union time were not significantly different between both groups (p>0.05). Clinically, the mean operation time, the amount of bleeding and transfusion, hospital duration and the mobility score were not significantly different (p>0.05). The post-operative complications were lag screw slippage over 25 mm (1 case) and loosening of device (1 case) in group I. In group II, there were perforation of the femoral head (1 case), nail breakage (1 case) and deep infection (1 case).
CONCLUSION
There was no significant differences that are clinical and radiological results in the treatment of AO/OTA A2.2 intertrochanteric fracture, using CHS and IM nail.

Citations

Citations to this article as recorded by  
  • A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures
    Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, In Hwa Back, Kyeong Soo Eom
    Journal of the Korean Orthopaedic Association.2016; 51(6): 493.     CrossRef
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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
J Korean Fract Soc 2013;26(1):37-43.   Published online January 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.1.37
AbstractAbstract PDF
PURPOSE
To compare the result between the third generation gamma nail (gamma 3 nail) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric fractures.
MATERIALS AND METHODS
Between March 2009 and June 2011, 47 consecutive patients with unstable intertrochanteric femoral fractures were treated with gamma 3 nail or PFNA. We reviewed 24 cases of gamma 3 nail and 23 cases of PFNA. Retrospectively, we evaluated the mean operation time, amount of bleeding, average union period, reduction status, change of neck shaft angle, Tip-apex distance, Cleveland index, sliding of lag screw and complication on set of telephone interview and outpatient. We also evaluated the postoperative capability of function and mobility, using 'Modified Koval index'.
RESULTS
There were no significant differences between the groups, which were treated with gamma 3 nail and PFNA. In addition, they did not show statistical difference. We experienced 2 cases of complication (gamma 3 nail 1 case, PFNA 1 case), which were cut-out of the femoral head.
CONCLUSION
The gamma 3 nail and PFNA were seen with good results in the treatment of unstable intertrochanteric fracture.

Citations

Citations to this article as recorded by  
  • Comparative analysis of operation time and intraoperative fluoroscopy time in intramedullary and extramedullary fixation of trochanteric fractures
    Milan Mitkovic, Sasa Milenkovic, Ivan Micic, Predrag Stojiljkovic, Igor Kostic, Milorad Mitkovic
    Vojnosanitetski pregled.2022; 79(2): 177.     CrossRef
  • 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
  • The Curative Effect Comparison Between Prolonged Third Generation of Gamma Nail and Prolonged Dynamic Hip Screw Internal Fixation in Treating Femoral Intertrochanteric Fracture and the Effect on Infection
    Wenye He, Wei Zhang
    Cell Biochemistry and Biophysics.2015; 71(2): 695.     CrossRef
  • Accuracy of the Lesser Trochanter for Guiding Lag Screw Insertion in Hip Fracture Management
    Jianlin Xiao, Zhongli Gao, Yanguo Qin, Xuezhou Li, Ao Wang, Lanyu Zhu, Jincheng Wang
    Orthopedics.2014;[Epub]     CrossRef
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