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

doi:10.12671/jkfs.2021.34.2.64

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Original Article 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; Journal of Musculoskeletal Trauma 2021;34(2):64-70.
DOI: https://doi.org/10.12671/jkfs.2021.34.2.64
Published online: April 30, 2021

Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea

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Abstract

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.

Keywords: Femur, Intertrochanteric fractures, Lag screw

J Korean Fract Soc. 2021 Apr;34(2):64-70. Korean.
Published online Apr 23, 2021.
https://doi.org/10.12671/jkfs.2021.34.2.64

Original Article

Comparison of Reductions of Left and Right Proximal Portions of Intertrochanteric Fractures Treated by Intramedullary Nailing

Hyun Cheol Oh

, M.D., Joong Won Ha

, M.D., Yung Park

, M.D., Sang Hoon Park

, M.D. and Han Kook Yoon

, M.D.

Author information

Author notes

- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Correspondence to: Han Kook Yoon, M.D. Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea. Tel: +82-31-900-0540, Fax: +82-31-900-0343, Email: hangugy@nhimc.or.kr

Received December 31, 2020; Revised January 18, 2021; Accepted March 19, 2021.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 diagnosis 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.

Keywords

Femur, Intertrochanteric fractures, Lag screw

Figures

Fig. 1
Artificial femoral bone of the right side, when a lag screw is inserted, it generates a clockwise rotational force and the proximal fragment is rotated internally.

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Fig. 2
Artificial femoral bone of the left side, when a lag screw is inserted, it generates a clockwise rotational force and the proximal fragment is rotated externally.

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Fig. 3
The proximal fragment was located in the intramedullary area (A) and the extramedullary area (B). The proximal fragment rotated internally (C) and externally (D).

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Fig. 4
An 85-year-old female patient with left side intertrochanteric fracture underwent surgery using a proximal femur nail. (A) Preoperative anteroposterior and axial radiographs showing a displaced intertrochanteric fracture. (B) Initial three-dimensional computed tomography (CT) revealed an AO/OTA 31-A2.3 fracture. (C) Preoperative axial CT of the proximal greater trochanter area showing that the proximal fragment had been displaced slightly posteriorly (arrow). (D) Preoperative axial CT of the lesser trochanter area showing that the proximal fragment had been displaced posteriorly and intramedullary (arrow). (E) Postoperative anteroposterior and axial radiograph showing that the proximal fragment had been displaced medially and anteriorly. (F) Postoperative axial CT of the proximal greater trochanter area showing that proximal fragment had been displaced posteriorly as compared with its preoperative position (arrow). (G) Postoperative axial CT of the lesser trochanter area showing that the proximal fragment had been displaced anteriorly. These observations showed the proximal fragment had rotated externally (arrow).

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Tables

Table 1
Patient Demographics

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Table 2
Comparison of Results

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Notes

Financial support:This work was supported by National Health Insurance Service Ilsan Hospital grant NHIMC2016CR057.

Conflict of interests:None.

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Citations

Citations to this article as recorded by

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Comparison of Reductions of Left and Right Proximal Portions of Intertrochanteric Fractures Treated by Intramedullary Nailing

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