J Korean Fract Soc.  2007 Jan;20(1):40-44. 10.12671/jkfs.2007.20.1.40.

Treatment of Intertrochanteric Fracture with Proximal Femoral Nail

Affiliations
  • 1Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea. paedic@chol.com

Abstract

PURPOSE
To evaluate the efficacy of proximal femoral nail for intertrochanteric fracture.
MATERIALS AND METHODS
From June 2001 to March 2005, 45 intertrochanteric fractures were treated with a proximal femoral nail for intertrochanteric fracture and followed-up at least one year. The average age was 71.3 years (34~91 years). The causes of fracture were slip down in 38 cases and fall down in 7 cases. Fractures were classified with AO classification; 20 cases in type A1, 22 cases in type A2 and 3 cases in type A3. Antirotational pin was used in 25 of 45 fractures according to fracture stability. Radiological result was determined with a union. Walking ability was evaluated in the last follow-up.
RESULTS
The fractures were fixed in anatomical position in 36 cases, in valgus position in 3 cases and varus position in 6 cases. Union was occurred in 43 of 45 cases. The sliding distance of lag screw was an average of 5.63 mm and it had no association with fracture type, TAD, usage of antirational screw, usage of distal screw and BMD. Twenty-six of 45 patients (57.7%) were recovered to pre-injury state of walking ability. Complications were occurred in 3 patients (6%).
CONCLUSION
Proximal femoral nail was a useful instrument for all type intertrochanteric fractures, but antirotational pin was not necessary in the stable type A1 intertrochnatirc fractures.

Keyword

Femur; Intertrochanteric fracture; Proximal femoral nail

MeSH Terms

Classification
Femur
Follow-Up Studies
Hip Fractures
Humans
Walking

Figure

  • Fig. 1 Photograph shows a measurement of neck diameter and a diameter that was made by two pin. A indicate femoral neck diameter. B indicates sum of diameter of two screws and their interspace.

  • Fig. 2 A 69 year old female who underwent internal fixation with a proximal femoral nail for intertrochanteric fracture. Radiograph shows no more space to insert an antirotational pin after fixation of lag screw.

  • Fig. 3 This diagram shows the distribution of femoral neck diameter of neck diameter of 44 patients.

  • Fig. 4 (A) A 72 year old man had a nonunion with metal failure 7 months after internal fixation with proximal femoral nail for intertrochanteric fracture. (B) The nail breakage occurred through the hole for lag screw.


Cited by  1 articles

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteic Fractures in the Elderly
Byung-Hak Kim, Young-Yool Chung, Sung-Chang Ki, Dae-Hyun Yoon, Ji-Hoon Ryu
J Korean Orthop Assoc. 2011;46(5):399-404.    doi: 10.4055/jkoa.2011.46.5.399.


Reference

1. Albareda J, Laderiga A, Palanca D, Paniagua L, Seral F. Complications and technical problems with the gamma nail. Int Orthop. 1996; 20:47–50.
Article
2. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)- a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003; 74:53–58.
Article
3. Crawford CH, Malkani AL, Cordray S, Roberts CS, Sligar W. The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures: a review of 93 cases. J Trauma. 2006; 60:325–328.
Article
4. Gadegone WM, Salphale YS. Proximal femoral nail - an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2006; Epub ahead of print.
5. Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hipscrew with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998; 80:618–630.
Article
6. Karkos CD, Hughes R, Prasad V, D'Souza SP. Thigh compartment syndrome as a result of a false aneurysm of the profunda femoris artery complicating fixation of an intertrochanteric fracture. J Trauma. 1999; 47:393–395.
Article
7. Kim BS, Lew SU, Ko SH, Cho SD, Yang JH, Park MS. Treatment of femoral intertrochanteric fracture with proximal femoral nail. J Korean Fract Soc. 2004; 17:1–6.
Article
8. Kim CK, Jin JW, Ahn BW, et al. Intertrochanteric fractures of femur treated with a proximal femoral nail. J Korean Hip Soc. 2005; 17:99–105.
9. Kim SY, Noh JH. Management of femoral peritrochanteric fracture with proximal femoral nail. J Korean Orthop Assoc. 2006; 41:541–546.
Article
10. Ko SB, Cho MR, Kim TH, Chang IW. Nailing in the patients with intertrochanteric fractures of the femur. Comparison gamma nail and proximal femoral nail. J Korean Fract Soc. 2004; 17:295–300.
Article
11. Laohapoonrungsee A, Sirirungruangsarn Y, Arpornchayanon O. Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: two cases report. J Med Assoc Thai. 2005; 88:1703–1706.
12. Moon DH, Choi JS, Kim GB, Kim JW, Kim KT. Treatment of unstable intertrochanteric femoral fracture with the AO/ASIF proximal femoral nail (PEN). J Korean Soc Fract. 2003; 16:136–142.
Article
13. Moon YW, Suh DH, Kang ST, Kwon DJ, Ji YN, Lee KB. The proximal femoral nail for intertrochanteric fracture of the femur. J Korean Soc Fract. 2003; 16:29–36.
Article
14. Robinson CM, Houshian S, Khan LA. Trochanteric-entry long cephalomedullary nailing of subtrochanteric fractures caused by low-energy trauma. J Bone Joint Surg Am. 2005; 87:2217–2226.
Article
15. Sung YB, Nam CH, Ahn JK, Sohn YJ, Chung HJ, Kim JH. A comparative study between the femoral femoral nail and dynamic hip screw for intertrochanteric fracture. J Korean Hip Soc. 2002; 14:208–215.
16. Utrilla AL, Reig JS, Munoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma. 2005; 19:229–233.
Article
17. Yang KH, Park HW, Park SJ. Pseudoaneurysm of the superficial femoral artery after closed hip nailing with a Gamma nail: report of a case. J Orthop Trauma. 2002; 16:124–127.
Article
Full Text Links
  • JKFS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr