Hip Pelvis.  2017 Dec;29(4):270-276. 10.5371/hp.2017.29.4.270.

Outcomes of Cephalomedullary Nailing in Basicervical Fracture

• Kweon SH
• Lee SH
• Kook SH
• Choi YC

• KMID: 2424254
• DOI: http://doi.org/10.5371/hp.2017.29.4.270

Abstract

PURPOSE
A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing.
MATERIALS AND METHODS
Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up.
RESULTS
In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0-21.1 mm), which showed insertion point of < 25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1-16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3-10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P < 0.05).
CONCLUSION
In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.

Keyword

Femur; Basicervical fractures; Intramedullary fracture fixation

MeSH Terms

Aged
Arthritis
Femoral Fractures
Femur
Follow-Up Studies
Fracture Fixation, Intramedullary
Hip
Humans
Methods
Neck
Ontario
Radiography

Figure

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  Fig. 1 Images of an female patient aged 90 years old. (A) Anteroposterior X-ray shows a basicervical fracture in the right hip that had occurred after a simple fall. (B) Computed tomography shows the axial section of fracture level.

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  Fig. 2 During insertion of an intramedullary nail's massive empennage, there is a distraction effect (V effect) on the trochanteric fragments, which increases the incidence of hip varus deformity or nonunion (A). With the assistant holding the proximal-medial part of basicervical fracture line in position (B), a reamer with high rotation speed can be used to enlarge the proximal femur; this diminishes the V effect and lag screw malposition (C).

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  Fig. 3 For the Cleveland index, the femur head is divided into nine zones in the axial view to classify the position of the cervical screw.

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  Fig. 4 (A) Initial radiograph in 77-year-old female patient show a basicervical fracture in the left hip. (B) Immediate postoperative radiograph shows that fixation was done with Gamma. (C) Radiograph at 12 months shows the bone union at the fracture site.

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