Treatment of Intertrochanteric Fracture with Multiple Flexible Intramedullary Nails

Moon, Myung Sang; Kim, Han Joo; Lee, Dong Sik; Lee, Young Soo

Abstract

Recently, morbidity and mortality are reduced in elderly trochanteric fracture patients, which is best accomplished with multiple flexible intramedullary nail fixation under image intensifier control. Condylocephalic nailing of the trochanteric fractures offers four advantages; Minimally traumatic, short operation time, little blood loss, and very early weight bearing on the injured limb after surgery. The authors treated 15 cases of intertrochanteric fractures from June 1981 to March 1983 with multiple flexible intramedullary nails (Ender or P.G.P.). The results obtained were as follows; l. Among 15 cases, two patients were ages between 41 and 50, there between 51 and 60, one between 61 and 70, seven between 71 and 80, and two patients above 81 years, Nine were men and six women. 2. The average operation time was 60 minutes (range, 30 to 150 minutes) and average blood loss was 140ml (range, 50 to 400ml). After operation, Bucks extension traction was applied for 3 weeks in three cases. 3. Partial weight bearing ambulation was recommended one day after operation in eleven cases, and at 21th days in the other three cases. Full weight bearing ambulation, using appropriate assistive devices, was recommended as early as possible. 4. The clinical union was obtained as early as 5 weeks after operation in 7 cases, 9 weeks in two cases and 12 weeks in one case. 5. Among the complications, downward migration of the nail occured in two patients. With early weight-bearing, varus deformity due to collapse of the reduced fracture resulting secondary leg shortening (less than 3 cm) occured in 8 cases and mild external rotation deformity of lower leg in 3 cases (less than 15), but did not present any clinical problem in elderly patients, Irritation by the nail tip caused pain around the knee and also developed the partial stiffness of the joints temporarily after surgery. No nails migrated into the oits. It was felt that most difficult thing to manage was the maintenance of reduced fracture till clinical union to prevent varus deformity and distal nail migration, and the method was technically simple and could be employed succesfully.