Hip Pelvis.  2019 Dec;31(4):190-199. 10.5371/hp.2019.31.4.190.

Characteristics and Surgical Outcomes of Intertrochanteric or Subtrochanteric Fractures Associated with Ipsilateral Femoral Shaft Fractures Treated with Closed Intramedullary Nailing: A Review of 31 Consecutive Cases over Four Years at a Single Institution

• Seong YJ
• Jang JH
• Jeon SB
• Moon NH

• KMID: 2464235
• DOI: http://doi.org/10.5371/hp.2019.31.4.190

Abstract

PURPOSE
To evaluate the clinical characteristics of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures and assess the surgical outcomes of a novel, closed intramedullary nailing surgical approach designed to minimize fixation failure.
MATERIALS AND METHODS
Between May 2013 and April 2017, 31 patients with intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures treated with closed intramedullary nailing or long proximal femoral nail antirotation (PFNA) were enrolled in this study. Preoperative data included age, sex, injury severity score, body mass index, location of shaft fracture, injury mechanism, accompanying traumatic injury, walking ability before injury, and surgical timing. Perioperative outcomes, including follow-up period, types of intramedullary nails, number of blocking screws used, operation time, and blood loss were assessed. Radiologic outcomes, including union rate, time from surgery to union, and femoral shortening, and clinical outcomes, including hip flexion, walking ability, and Harris hip score were also evaluated.
RESULTS
A total of 29 unions (93.5%) were achieved. The time to union was 16.8 months (range, 11-25 months) for hip fractures (15.7 weeks for intertrochanteric fractures and 21.7 weeks for subtrochanteric fractures) and 22.8 months for femoral shaft fractures. There were no significant differences in surgical outcomes between the two groups except for type of intramedullary nail.
CONCLUSION
Closed intramedullary nailing in the treatment of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures may be a good surgical option. However, fixation of femoral shaft fractures might not be sufficient depending on the implant design.

Keyword

Ipsilateral femoral fracture; Femoral shaft fracture; Intramedullary nailing; Intertrochanteric fracture; Subtrochanteric fracture

MeSH Terms

Body Mass Index
Follow-Up Studies
Fracture Fixation, Intramedullary*
Hip
Hip Fractures*
Humans
Injury Severity Score
Walking

Figure

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  Fig. 1 The minimally invasive reduction technique designed for proximal fragments of a peritrochanteric fracture. (A–C) The reduction of flexion and external rotation deformity of the proximal fragment using long Kelly forcep and bone hook. (D–F) The reduction of medially displaced proximal fragment of intertrochanteric fracture using a long Kelly forcep.

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  Fig. 2 (A–C) Ipsilateral intertrochanteric and femoral shaft fracture treated with long proximal femoral nail antirotation and two blocking screws. (D–F) Ipsilateral subtrochanteric and femoral shaft fracture treated with A2FN and one blocking screw.

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  Fig. 3 (A–C) The distal portion of the femoral shaft fracture displaced posteriorly was reduced by lifting the femur using the Steinmann pin and fixation of the blocking screws. (D–F) The blocking screws were routinely inserted when the long proximal femoral nail antirotation was used in infra-isthmic type fractures.

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  Fig. 4 (A, B) A 27-year-old male patient with an ipsilateral intertrochanteric and femoral shaft fracture. (C) Postoperative radiography following fixation with proximal femoral nail antirotation (PFNA) and three blocking screws. (D, E) Hypertrophic non-union was identified in the femoral shaft fracture (arrows). (F, G) A 24-year-old male patient with an ipsilateral subtrochanteric and femoral shaft fracture. (H) Postoperative radiography following fixation with long PFNA, percutaneous wire, and two blocking screws. (I, J) Hypertrophic non-union was identified in the femoral shaft fracture (arrows).

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