Chi Hyoung Pak; Sang Hong Lee; Sang Ho Ha; Gwang Chul Lee; Kyoung Chul Song

doi:10.12671/jkfs.2013.26.4.284

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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation: Chi Hyoung Pak, M.D., Sang Hong Lee, M.D., Sang Ho Ha, M.D., Gwang Chul Lee, M.D., Kyoung Chul Song, M.D.; Journal of the Korean Fracture Society 2013;26(4):284-291.
DOI: https://doi.org/10.12671/jkfs.2013.26.4.284
Published online: October 18, 2013

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Sang Hong Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, shalee@chosun.ac.kr

• Received: June 10, 2013 • Revised: July 3, 2013 • Accepted: August 14, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

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.
Key words: Femur, Subtrochanteric fracture, Proximal femoral nail anti-rotation

The present study was supported by grants from the Clinical Medicine Research Institute at Chosun University Hospital.

REFERENCES

1. Afsari A, Liporace F, Lindvall E, Infante A Jr, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high subtrochanteric fractures of the femur: surgical technique. J Bone Joint Surg Am, 2010;92:Suppl 1 Pt 2. 217-225.PubMed
2. Boopalan PR, Jepegnanam TS, Nithyananth M, Venkatesh K, Cherian VM. Functional outcome of biological condylar blade plating of subtrochanteric fractures. J Orthop Sci, 2012;17:567-573.Article PubMed
3. Borens O, Wettstein M, Kombot C, Chevalley F, Mouhsine E, Garofalo R. Long gamma nail in the treatment of subtrochanteric fractures. Arch Orthop Trauma Surg, 2004;124:443-447.Article PubMed PDF
4. Byun YS. Minimally invasive plate osteosynthesis, MIPO. J Korean Fract Soc, 2007;20:99-114.Article
5. Choi JS, Moon DH, Noh YT. The treatment of subtrochanteric fracture with cephallomedually nail: minimal incision and lowman clamp assisted reduction. J Korean Fract Soc, 2011;24:301-306.Article
6. Chung PH, Kang S, Kim JP, Kim YS, Lee HM, Huh DJ. Treatment of unstable pertrochanteric fractures with a long intramedullary nail. Hip Pelvis, 2013;25:51-56.Article
7. Fielding JW, Cochran GV, Zickel RE. Biomechanical characteristics and surgical management of subtrochanteric fractures. Orthop Clin North Am, 1974;5:629-650.Article PubMed
8. Forte ML, Virnig BA, Kane RL, et al. Geographic variation in device use for intertrochanteric hip fractures. J Bone Joint Surg Am, 2008;90:691-699.Article PubMed
9. French BG, Tornetta P 3rd. Use of an interlocked cephalomedullary nail for subtrochanteric fracture stabilization. Clin Orthop Relat Res, 1998;(348):95-100.Article
10. Froimson AI. Treatment of comminuted subtrochanteric fractures of the femur. Surg Gynecol Obstet, 1970;131:465-472.PubMed
11. Garg B, Marimuthu K, Kumar V, Malhotra R, Kotwal PP. Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial. Hip Int, 2011;21:531-536.PubMed
12. Haidukewych GJ, Berry DJ. Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop Relat Res, 2004;(419):185-188.Article PubMed
13. Herrera A, Domingo J, Martinez A. Results of osteosynthesis with the ITST nail in fractures of the trochanteric region of the femur. Int Orthop, 2008;32:767-772.Article PubMed PDF
14. Jiang LS, Shen L, Dai LY. Intramedullary fixation of subtrochanteric fractures with long proximal femoral nail or long gamma nail: technical notes and preliminary results. Ann Acad Med Singapore, 2007;36:821-826.Article PubMed
15. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of adl: a standardized measure of biological and psychosocial function. JAMA, 1963;185:914-919.Article PubMed
16. Kennedy MT, Mitra A, Hierlihy TG, Harty JA, Reidy D, Dolan M. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury, 2011;42:1317-1321.Article PubMed
17. Kim JH, Lee SH, Lee KC, Cho SW. The PFNA nail for pertrochanteric fracture of the femur without fracture table. J Korean Fract Soc, 2011;24:217-222.Article
18. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res, 1989;(238):122-130.
19. Koch JC. The laws of bone architecture. Am J Anat, 1917;21:117-298.Article
20. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res, 1995;(310):150-159.
21. Kulkarni SS, Moran CG. Results of dynamic condylar screw for subtrochanteric fractures. Injury, 2003;34:117-122.Article PubMed
22. Macheras GA, Koutsostathis SD, Galanakos S, Kateros K, Papadakis SA. Does PFNA II avoid lateral cortex impingement for unstable peritrochanteric fractures? Clin Orthop Relat Res, 2012;470:3067-3076.Article PubMed PMC
23. Micic ID, Mitkovic MB, Park IH, et al. Treatment of subtrochanteric femoral fractures using Selfdynamisable internal fixator. Clin Orthop Surg, 2010;2:227-231.Article PubMed PMC
24. Park J, Yang KH. Correction of malalignment in proximal femoral nailing--Reduction technique of displaced proximal fragment. Injury, 2010;41:634-638.Article PubMed
25. Pelet S, Arlettaz Y, Chevalley F. Osteosynthesis of perand subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study. Swiss Surg, 2001;7:126-133.PubMed
26. Saini P, Kumar R, Shekhawat V, Joshi N, Bansal M, Kumar S. Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate. Injury, 2013;44:226-231.Article PubMed
27. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP. Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury, 2007;38:1286-1293.Article PubMed
28. Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury, 2008;39:932-939.Article PubMed
29. Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury, 2006;37:984-989.PubMed
30. Windolf J, Hollander DA, Hakimi M, Linhart W. Pitfalls and complications in the use of the proximal femoral nail. Langenbecks Arch Surg, 2005;390:59-65.Article PubMed PDF

Fig. 1

(A) Preoperative radiograph shows comminution subtrochanteric fracture of a 61-year-old male from a 2 m fall.

(B-D) The fracture was reduced satisfactorily using percutaneous reduction forceps to reverse the deforming forces.

(E-G) After using limited open incision, bone hook is maintained in place until a lag screw guide pin is placed in the proper position of the femoral head to prevent recurrence of flexion deformity.

(H, I) Postoperative hip anteroposterior and lateral view show a well-reduced subtrochanteric fracture treated with a single large lag-screw cephalomedullary device.

Fig. 2

(A-C) Initial hip Anteroposterior view, hip joint lateral and pelvis computed tomography images show a spiral subtrochanteric fracture of the femur with a large fragment.

(D, E) The fracture was reduced satisfactorily using cable grip and proximal femoral nail antirotation after surgery.

(F, G) Fracture healing is evident 1 year after surgery.

(H, I) Limited open reduction through a small incision with cable grip was done before nail insertion.

Table 1

Katz Activities of Daily Living Index

Independence: 1, Dependence: 0.

Table 2

Koval Score

Table 3

Comparison of Results for Comminution, Reduction Method, Cleveland Index

Nonunion: 2 cases.

Figure & Data

REFERENCES

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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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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

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

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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

Fig. 1 (A) Preoperative radiograph shows comminution subtrochanteric fracture of a 61-year-old male from a 2 m fall. (B-D) The fracture was reduced satisfactorily using percutaneous reduction forceps to reverse the deforming forces. (E-G) After using limited open incision, bone hook is maintained in place until a lag screw guide pin is placed in the proper position of the femoral head to prevent recurrence of flexion deformity. (H, I) Postoperative hip anteroposterior and lateral view show a well-reduced subtrochanteric fracture treated with a single large lag-screw cephalomedullary device.

Fig. 2 (A-C) Initial hip Anteroposterior view, hip joint lateral and pelvis computed tomography images show a spiral subtrochanteric fracture of the femur with a large fragment. (D, E) The fracture was reduced satisfactorily using cable grip and proximal femoral nail antirotation after surgery. (F, G) Fracture healing is evident 1 year after surgery. (H, I) Limited open reduction through a small incision with cable grip was done before nail insertion.

Fig. 1

Fig. 2

The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

Table 1

Katz Activities of Daily Living Index

Independence: 1, Dependence: 0.

Table 2

Koval Score

Table 3

Comparison of Results for Comminution, Reduction Method, Cleveland Index

Nonunion: 2 cases.

Table 1 Katz Activities of Daily Living Index

Independence: 1, Dependence: 0.

Table 2 Koval Score

Table 3 Comparison of Results for Comminution, Reduction Method, Cleveland Index

Nonunion: 2 cases.