J Korean Fract Soc.  2010 Apr;23(2):227-231. 10.12671/jkfs.2010.23.2.227.

Bursting Fracture of the Proximal Femur during Insertion of Unreamed Femoral Nail for Femur Shaft Fracture: A Case Report

• Kim JW
• Byun SE
• Oh WH
• Kim JJ

• KMID: 1461552
• DOI: http://doi.org/10.12671/jkfs.2010.23.2.227

Abstract

When treating femur shaft fracture in adults, undreamed nail can be an option in order to avoid systemic complications. To appropriately insert unreamed intramedullary nail, an accurate entry point and sufficient reaming of the entry portal is essential. The intramedullary canal of the proximal femur must be reamed over than the diameter of the proximal end of the nail. If the proximal reaming is not sufficient, complications such as bursting fracture of proximal femur can occur. We present two cases of bursting fracture of proximal femur following insertion of undreamed intramedullary nail as well as a literature review.

Keyword

Femur; Femurs shaft fracture; UFN; Complication; Intraoperative fracture

MeSH Terms

Adult
Femur
Humans
Nails

Figure

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  Figure 1 (A) Initial AP view shows AO type A3 femoral shaft fracture and contralateral femoral shaft. (B) Intraoperative C-arm image shows bursting fracture and (C) Bursting fracture is fixed by additional interlocking screw. (D) Postoperative AP and (E) lateral x-rays show union of femoral shaft fracture and bursting fracture.

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  Figure 2 (A) Initial AP view shows AO type B1 femoral shaft fracture. (B) Postoperative AP view, (C) lateral view, (D) preoperative 3D CT image and (E) postoperative 3D CT image show bursting fracture of proximal femur.

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  Figure 3 (A) Postoperative CT shows the appropriate entry point of the nail. (B) Preoperative CT shows 9.8 mm of diameter of the isthmus of the femur. (C) The x-ray shows the level of the following axial images (D~I).

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  Figure 4 The diameter of the most proximal part of the UFN is 13 mm, the diameter of the following portion becomes slender and the diameter of the other part is 9~12 mm.

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  Figure 5 The comparison of proximal reamer for UFN and PFNA. (A) is the proximal reamer for PFNA and the end of PFNA proximal reamer is tapered, and (B) is the proximal reamer for UFN.

Reference

1. Abbas D, Faisal M, Butt MS. Unreamed femoral nailing. Injury. 2000. 31:711–717.

2. Alho A, Strømsøe K, Ekeland A. Locked intramedullary nailing of femoral shaft fractures. J Trauma. 1991. 31:49–59.

3. Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed. J Am Acad Orthop Surg. 2000. 8:83–90.

4. Canadian Orthopaedic Trauma Society. Reamed versus unreamed intramedullary nailing of the femur: comparison of the rate of ARDS in multiple injured patients. J Orthop Trauma. 2006. 20:384–387.

5. Forster MC, Aster AS, Ahmed S. Reaming during anterograde femoral nailing: is it worth it? Injury. 2005. 36:445–449.

6. Johnson KD, Tencer AF, Sherman MC. Biomechanical factors affecting fracture stability and femoral bursting in closed intramedullary nailing of femoral shaft fractures, with illustrative case presentations. J Orthop Trauma. 1987. 1:1–11.

7. Papadakis SA, Zalavras C, Mirzayan R, Shepherd L. Undetected iatrogenic lesions of the anterior femoral shaft during intramedullary nailing: a cadaveric study. J Orthop Surg Res. 2008. 3:30.

8. Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures. J Orthop Trauma. 2001. 15:28–32.

9. Tencer AF, Sherman MC, Johnson KD. Biomechanical factors affecting fracture stability and femoral bursting in closed intramedullary rod fixation of femur fractures. J Biomech Eng. 1985. 107:104–111.

10. Yoon HK, Jeon KP, Kang KH, Kim JI, Kim DS, Koh YK. A Clinical Comparative Study of Reamed and Unreamed Nail of Femoral Shaft Fracture. J Korean Soc Fract. 1998. 11:495–500.