Journal of Musculoskeletal Trauma

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

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.

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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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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

Abstract 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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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

Abstract 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.

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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

Abstract 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.

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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

Abstract 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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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

Abstract 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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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

Abstract 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

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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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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

Abstract 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

Abstract 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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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

Abstract 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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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

Abstract 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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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

Abstract 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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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

Abstract 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.

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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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The Treatment of Intertrochanteric Femoral Fracture with Proximal Femoral Nail Antirotation: Jong Won Kim, Hyun Soo Park, Young Soo Jang, Jae Hyuk Choi, Sung Ju Bae, Chan Il Bae; J Korean Fract Soc 2012;25(4):257-262. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.257

Abstract PDF: PURPOSE
This study was performed to evaluate the results of treating intertrochanteric fracture with proximal femoral nail antirotation (PFNA).
MATERIALS AND METHODS
We performed PFNA on 41 intertrochanteric femur fracture patients from May 2008, to August 2010. We analyzed the operation time, blood loss, recovery of ambulatory function, T-score, the tip apex distance (TAD), the sliding distance of the blade, neck-shaft angle, and complications.
RESULTS
The mean operation time was 51 minutes and the mean amount of blood loss was 350 ml. The time to ambulation averaged 7.2 days. Thirty-two cases (79%) recovered their previous walking status at 6 months after operation. The average T-score was 3.3 and TAD was 12.3 mm (8.6~27 mm). 35 cases (87%) achieved acceptable reduction. The average amount of PFNA blade sliding was 3.3 mm. The neck-shaft angle was changed 2.6 degrees varus displacement at the final follow-up. There was one case of nonunion due to tuberculosis infection.
CONCLUSION
The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of intertrochanteric fracture of the femur.

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Bleeding Volume after Surgery for Trochanteric Fractures of the Femur in Patients Treated with Antiplatelet Agents: Comparison according to Surgical Timing: Se Ang Jang, Young Ho Cho, Young Soo Byun, Tae Gyun Kim, Hun Sik Cho, Sung Choi; J Korean Fract Soc 2012;25(2):105-109. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.105

Abstract PDF

PURPOSE
We evaluated the bleeding volume after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents according to surgical timing.
MATERIALS AND METHODS
We selected 20 patients who had trochanteric fractures of the femur treated with antiplatelet agents from January 2009 to June 2010. Group I included 9 patients who discontinued antiplatelet medication and had delayed operations at an average of 6.5 days and Group II included 11 patients who underwent early operations within 24 hours. Group I included 2 males and 7 females; their average age was 77.8 years (range 59~86). Group II included 4 males and 7 females, with an average age of 73.5 years (range 61~84). We compared the two groups' volume of intraoperative bleeding, the preoperative and postoperative hemoglobin levels and the volume of postoperative transfusion. The Mann-Whitney U test was used for statistical analysis.
RESULTS
The volume of intraoperative bleeding was 88 ml in group I and 106 ml in group II (p>0.01). The difference in the hemoglobin was a decrease of 2.4 mg% in group I and a decrease of 2.2 mg% in group II (p>0.01). The volume of postoperative transfusion was 0.6 pints in group I and 1 pint in group II (p>0.01).
CONCLUSION
We found a similar bleeding volume regardless of operative timing after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents.

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Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression
B. Doleman, I.K. Moppett
Injury.2015; 46(6): 954. CrossRef
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
Journal of the Korean Fracture Society.2013; 26(3): 199. 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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Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN): Kee Byoung Lee, Byung Taek Lee; J Korean Fract Soc 2007;20(1):33-39. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.33

Abstract PDF

PURPOSE
We analyzed the complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFNÂ®) to reduce the its complications.
MATERIALS AND METHODS
We evaluated the complications among 198 patients who were treated with PFNÂ® from June 2001 to August 2005 in our hospital.
RESULTS
The complications were presented in 28 cases (14.1%). Cut-out of lag screw was in 1 case, cut-out of lag screw and antirotation screw were in 3 cases, cut-out of antirotation screw in 3 cases, of these femoral head fracture was in 1 case. Femoral neck fracture in 1 case, Osteonecrosis of femoral head in 1 case, cortical fracture during the insertion of distal interlocking screw in 1 case, breakage of drill bit intraoperatively in 1 case, fibrous union in 2 case, thigh skin irritation due to screw back-out in 3 cases, periprosthetic fractures in 2 cases, varus collapse more than 10 degrees in 4 cases, superficial and deep infections in 3 cases, breakage of nail in 1 case, varus collapse after PFN removal in 1 case, persistent thigh pain in 1 case. Of all these cases, 9 cases (4.5%) were required reoperation with general or spinal anesthesia. Complications related with screws or fracture reduction were 19 cases (9.6%) and, of these, 17 cases (89.5%) showed increased TAD (tip apex distance) or nonanatomical reduction.
CONCLUSION
To reduce the complications of PFNÂ®, we need to exact surgical technique and anatomical reduction and consider the modification of implant design to prevent of cut-out of screws.

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Won Chul Shin, Jung Dong Seo, Sang Min Lee, Nam Hoon Moon, Jung Sub Lee, Kuen Tak Suh
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Antonio Barquet, Gabriel Mayora, Joao Matheus Guimaraes, Roberto Suárez, Peter V. Giannoudis
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Jong-Seok Park, Woo-Jong Kim, Jae-Wan Soh, Byung-Woong Jang, Tae-Heon Kim, You-Sung Suh
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PFNA and PFN in Intertrochanteric Fractures - Comparison Study of Sliding -
Suk Kyu Choo, Hyoung Keun Oh, Jun Young Choi
Hip & Pelvis.2010; 22(1): 79. 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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Comparison of Clinical Results between Bipolar Hemiarthroplasty and Compression Hip Screw on Unstable Intertrochanteric Fractures of the Femur in Elderly Patients: Eui seoung Yoon, Hak Jin Min, Jae Seong Suh, Yoon Jong Kim, Hee Seon Kim, Yong Jun Lee, Jeong Min Heo; J Korean Fract Soc 2004;17(3):214-220. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.214

Abstract PDF

PURPOSE
To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients.
MATERIALS AND METHODS
78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test.
RESULTS
The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p<0.05). The mortality rates were 28% and 22% respectively and there were no significant differences statistically (p>0.05).
CONCLUSION
We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.

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Outcomes of Cephalomedullary Nailing in Basicervical Fracture
Seok Hyun Kweon, Sung Hyun Lee, Seng Hwan Kook, Young Chae Choi
Hip & Pelvis.2017; 29(4): 270. CrossRef
Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients
Jin-Wan Kim, Young-Chul Ko, Chul-Young Jung, Il-Soo Eun, Hyeon-Soo Choi, Ok-Gul Kim, Young-June Kim
Journal of the Korean Fracture Society.2009; 22(4): 232. CrossRef
Bipolar Hemiarthroplasty for Femoral Basicervical Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-Jun Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2009; 22(4): 239. CrossRef
Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Hip Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-June Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2008; 21(3): 232. CrossRef
Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients
Duk-Hwan Kho, Ju-Yong Shin, Ki-Hwan Kim, Jun-Hyuck Lee, Dong-Heon Kim
Journal of the Korean Fracture Society.2007; 20(2): 129. CrossRef

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Common Modes of Fixation Failure with a Sliding Hip Screw encountered Unstable Intertrochanteric Fracture: Byung Soon Kim, Duck Yun Cho, Hyung Ku Yoon, Dong Eun Sin, Soo Hong Han, Jae Hwa Kim, Dong Jun Kim; J Korean Soc Fract 2003;16(1):15-21. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.15

Abstract PDF

The purpose of this study was to evaluate the common modes of fixation failure in unstable intertrochanteric fractures , related risk factors and the prevention of fixation failure. Between 1995 and 2001, 44 patients who had sustained an unstable intertrochanteric fractures were assigned to be treated with a sliding hip screw. Men in 14 cases ( 32% ), women in 30 cases ( 68% ) , the average age at the operation was 65(22-90) years and the average duration of follow up was 12(8-22) months. We classified the fracture patterns with Evans system and used Singh 's index for osteoporosis. And we examined the common modes of fixation failure with postoperative X-ray. The fixation failure in unstable intertrochanteric fracture was 8 cases (18.2 % ); varus collapse of the proximal fragment with cutout of the lag screw was 3 cases (6.8%), varus collapse of the proximal fragment with excessive sliding of the lag screw was 4 cases (9.1%) and loss of fixation of the plate-holding screws was 1 case (2.3%). The authors think that inadequate anatomical reduction of comminuted posteromedial fragment and severity of osteoporosis are main causes of fixation failure. During operation for unstable intertrochanteric fractures, the most important point is accurate reduction of posteromedial fragment and the intramedullary hip screw like proximal femoral nail ( PFN ) may be considered to avoid fracture of lateral cortex that enter the lag screw, causing fixation failure.

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The Antero-medial Cortex Overlapped Reduction of Unstable Intertrochanteric Fractures
Chae-Geun Kim, Suc-Hyun Kweon, Hong-Jun Han, Jae-Seon Hwang
Hip & Pelvis.2013; 25(4): 280. 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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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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Use of Gamma Nail in Peritrochanteric Fractures of the femur : A comparative study of Asian-Pacific type with Standard-European type: Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Dong Kyu Shin, Young Joon Youn; J Korean Soc Fract 1999;12(4):786-791. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.786

Abstract PDF: PURPOSE
: The mismatch of the Standard Gammd nail(SU) in oriental people led to the modification of the delign of its femoral shaft component and use of the Asian-Pacific type(AP). We compared the clinical results of 2 groups of femoral peritrochanteric fractures treated with each type of Gamma nail.
MATERIALS and METHODS
: 65 cases of peritrochanteric fractures of the femur(AP 24 cases, SU 42 cases) were studied with regard to operation time, union time and complications. The cases in each group were similar in fracture pattern, degree of osteoporosis and time interval between trauma and operation.
RESULTS
There were no significant differencef between two groups in operation time, intraoperative blood loss, and union time. Lateral cortical fracture and nail breakage were not observed in AP group but lag screw cutout was more frequent in AP group(8%) than in SU group(2%), but other complications were similar in type and frequency between two groups.
CONCLUSION
: AP Camma nail showed somewhat improved matching with the configuration of Korean femora, but further modification of the design might be needed to solve remained problems such as nail protrusion above trochanter.

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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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