Is Full-Length Intramedullary Nail Necessary for Atypical Subtrochanteric Femoral Fracture Associated with Bisphosphonate?

Background@#American Society for Bone and Mineral Research recommend the use of intramedullary reconstruction of full length-nail for atypical subtrochanteric femoral fracture (ASFF). However, there is no study on the incidence of the ipsilateral femoral fracture after index operation of ASFF, and full-length nail has disadvantage as iatrogenic fracture and leg length discrepancy (LLD). The aim of this study was to investigate the incidence of ipsilateral secondary fracture after using partial-length nail, and to compare the outcomes on surgery of ASFF between partial length-nails and full length-nails. @*Methods@#Forty-five consecutive fractures with ASFFs which had undergone intramedullary fixation using cephalomedullary nail between 2011 and 2018 were enrolled. The 45 cases were grouped based on nail length into the partial-length nail group (n=26) and the full-length nail group (n=19). Ipsilateral secondary fracture, time to union, intra-operative iatrogenic fracture, metal failure, LLD, operative duration, and post-operative 24-hr blood loss were investigated. @*Results@#There was no ipsilateral secondary fracture after index operation. There were no statistically significant differences between the partial-length nail and full-length nail groups in the time to union, LLD, and post-operative 24-hr blood loss (P=0.427, 0.478, and 0.228, respectively). Operative duration showed statistically significant difference between 2 groups (P=0.034). Metal failure were occurred in 1 (3%) case of the partial-length nail group and 2 (10%) cases of the full-length nail group. Iatrogenic fractures during nail insertion occurred in 2 (7%) cases of the partial-length-nail group and 3 cases (15%) of the full-length nail group. @*Conclusions@#Although large scale studies are required, our study indicate that full-length nails are not usually required for the treatment of ASFF.

Acute Dorsal Compartment Syndrome of the Forearm in a Patient with Rhabdomyolysis / 대한정형외과학회잡지

There are three compartments of the forearm by fascia: volar, dorsal and lateral. Compartment syndrome of the forearm, which commonly develops in the volar deep compartment, can be induced by various causes. We experienced a case of acute dorsal compartment syndrome of the forearm in a patient with rhabdomyolysis. Because of severe pain and progressive palsy of the posterior interosseous nerve, fasciotomy and release of posterior interosseous nerve were performed. Acute compartment syndrome localized at the dorsal compartment of the forearm is very rare, and compartment syndrome of the forearm in a patient with rhabdomyolysis has not been reported previously. We report the case with review of literatures.