Clin Orthop Surg.  2011 Sep;3(3):217-224. 10.4055/cios.2011.3.3.217.

Technique and Early Results of Percutaneous Reduction of Sagittally Unstable Intertrochateric Fractures

• Chun YS
• Oh H
• Cho YJ
• Rhyu KH

• KMID: 1743912
• DOI: http://doi.org/10.4055/cios.2011.3.3.217

Abstract

BACKGROUND
This paper introduces a percutaneous reduction technique using one or two Steinman pin(s) to reduce sagittally unstable intertrochanteric fractures.
METHODS
A fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction. Of 119 intertrochanteric fractures treated from June 2007 to December 2008, twenty-one hips showed sagittal instability. The sagittal displacement was reduced using a Steinmann pin as a joystick, and stabilized with a nail device. Nineteen hips were followed up for more than one year. The clinical and radiological results were reviewed in 19 hips and compared with those of the remaining cases.
RESULTS
The demographics were similar in both groups. The mean anesthetic time did not differ. Although the pre-injury and final activity levels were significantly lower in the study group, the degree of recovery was the same. No clinical complications related to this technique were encountered. Radiologically, the reduction was good in all hips in both groups. Union was obtained in all cases without any time differences.
CONCLUSIONS
This less invasive reduction technique is simple and safe to use for this type of difficult fracture.

Keyword

Intertrochanteric fracture; Sagittal; Unstable; Percutaneous reduction

MeSH Terms

Aged
Aged, 80 and over
Bone Nails
Female
Fracture Fixation, Internal/*methods
Hip Fractures/radiography/*surgery
Humans
Male

Figure

• 

  Fig. 1 Anteroposterior fluoroscopic image of the left hip in 72-year-old woman showing a relatively simple long oblique intertrochanteric fracture that looks well reduced (A). The lateral fluoroscopic image of the same patient, however, shows that the sagittal geometry is unstable and that the distal fragment sags posteriorly (B).

• 

  Fig. 2 Photograph of the caudal side of the patient in the cephalad direction. Surgery was performed on the patient's left intertrochanteric fracture. Note the mallet was held to elevate the thigh and the Steinmann pin was controlled by an operator to obtain acceptable reduction in the lateral fluoroscopic view.

• 

  Fig. 3 For the same patient shown in Fig. 1, the proximal fragment was controlled so it buttressed the distal cortex medially (A) and anteriorly (B). The reduction could be maintained until the guide pin for the lag blade of the Proximal Femoral Nail Antirotation™ was introduced in the anteroposterior (C) and lateral (D) fluoroscopic images.

• 

  Fig. 4 Anteroposterior (AP; A) and lateral (B) radiographs of a 66-year-old patient showing an unstable fracture pattern. The proximal fragment was fixed in external rotation and simple traction worsened the fracture geometry (C). The fracture could be reduced and the reduction was maintained with the two-pin technique during the insertion of nail device (D). Successful reduction and stable fixation was confirmed in postoperative AP (E) and cross-table lateral (F) radiographs.

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