The Treatment of Trochanteric Fractures by Intramedullary Nail: Concerning Perioperative Complications

Wang, J H; Roh, K J; Yun, Y H; Kim, D J; Kim, D W; Kim, S W

Abstract

Trochanteric fractures of the femur are usually seen in the elderly with osteoporosis and in young adult by high energy trauma. These fractures need firm internal fixation and early weight bearing, and Gamma interlocking nail or intramedullary hip screw is commonly used for this purpose at present. We analysed 23 patients with trochanteric fracture, who were treated with Gamma-locking nail or intramedullary hip screw from July 1992 to June 1994 with minimum 1 year follow-up. The mean age was 70 years-old. The intertrochanteric fracture was seen in 21 cases and subtrochanteric fracture in 2 cases. The final outcome was achieved with less surgical time, less blood loss and earlier rehabilitation. In addition, in biomechanical point of view, the advantages of using these nails are in short lever arm and in short lever arm and in lower bending moment. However, complications were developed in 10 patients. Intraoperative complications included the problem due to mismatching of the femoral component of the nail in 7 cases, problems of distal target screw in 2 cases, femoral shaft fracture in 1 case and cortical fractures in 2 cases. Bursitis in 2 cases, progressive coxa vara in 2 cases, thigh and knee pain in 1 case were developed postoperatively. Although using a smaller modified nail reduced these complications and obtained better result, we conclude that with careful surgjcal technique, choice of accurate indication and suitable modified femoral component, the Gamma nail and intramedullary hip screw are an advance in the treatment of peritrochanteric fractures.