Hip Pelvis.  2013 Mar;25(1):51-56. 10.5371/hp.2013.25.1.51.

Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail

• Chung PH
• Kang S
• Kim JP
• Kim YS
• Lee HM
• Huh DJ

• KMID: 1425036
• DOI: http://doi.org/10.5371/hp.2013.25.1.51

Abstract

PURPOSE
The purpose of this study is to analyze the clinical and radiographic results of treatment of unstable pertrochanteric hip fractures in which the fracture line is extended distally or the width of the canal is wide using a long intramedullary nail.
MATERIALS AND METHODS
From January 2005 to January 2010, we conducted an analysis of 20 cases of unstable pertrochanteric hip fractures (over AO/OTA 31 A2.2) treated using a long intramedullary nailing and followed up for more than 12 months. Using postoperative and last follow-up radiographs, we measured TAD, Cleveland index, neck-shaft angle, sliding length of the lag screw, and union time. Clinically, we measured the operation time, the amount of transfusion, and Parker and Palmer's mobility score.
RESULTS
The mean bony union time was 16.4 weeks(10-21 weeks). The mean sliding length of the lag screw was 4.3 mm(1-10 mm) and the mean varus angulation after surgery was 5.1degrees(3-8degrees). The mean operative time was 118 min(60-140 min), and the mean transfusion amount was 2.0 pint(0-4 pint). According to Parker and Palmer's mobility score, mean preoperative score was 7.5 points and mean postoperative score at last follow-up was 6.9 points.
CONCLUSION
In treatment of unstable pertrochanteric hip fractures, when the fracture line was extended to below the lesser trochanteric level or the medullary canal width was wide, use of a long intramedullary nail showed excellent clinical and radiologic results and can be regarded as a good treatment option.

Keyword

Femur; Unstable pertrochanteric fracture; Long intramedullary nail

MeSH Terms

Femur
Follow-Up Studies
Fracture Fixation, Intramedullary
Hip Fractures
Nails
Operative Time

Figure

• 

  Fig. 1 (A) Canal diameter at lesser trochanter level. (B) Canal diameter at 2 cm above lesser trochanter. (C) Canal diameter at 7 cm below lesser trochanter. (D) Cortex diameter at isthmus. (E) Canal diameter at isthmus. Cortical index (CI) equals the ratio of the femoral diaphyseal diameter minus the intramedullary canal diameter over the femoral diaphyseal diameter: isthmus CI=(D-E)/D.

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  Fig. 2 (A) Initial radiograph of 77 years old male show A2.2 pertrochanteric hip fracture. (B) Fracture was fixed with long ITST nail. (C) Radiograph at postoperative 6 months shows complete union.

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