ABSTRACT
PURPOSE: The purpose of the study was to evaluate methods for treatment of femur subtrochanteric fractures using the intramedullary long nail. MATERIALS AND METHODS: This retrospective study included 44 patients (44 cases) who were available for follow-up for at least one year. The patients had undergone intramedullary fixation specifically with a long nail for traumatic femur subtrochanteric fractures during the period from June 2005 to May 2012 in Chosun University Hospital. The study compares two groups. For group 1, closed reduction was attempted, and group 2 underwent minimal open reduction. Group 1 included 27 cases, and group 2 included 17 cases. Study parameters included injury mechanism, fracture classification according to the Seinsheimer type, nail design, size of skin incision, alignment, bony union time, malunion or nonunion, and complications. RESULTS: Bony union times were 19.4 weeks (group 1) versus 21.4 weeks (group 2), but there were no statistical differences between the two groups with respect to gender, injury mechanism, fracture classification, or nail design. However, there were significant differences between the two groups with respect to skin incision, malalignment, and complications. Gender, injury mechanism, fracture classification, nail design, size of skin incision, minimal open reduction or close reduction, did not show a significant relationship with bony union. However, in cases of malalignment, the possibility of malunion increased 1.5 times per 1degrees increase in malaligment. CONCLUSION: In treatment of femur subtrochanteric fracture using intramedullary nail, nonunion rate increases when malalignment occurs. Therefore, anatomical reduction with minimal open reduction is necessary if closed reduction is not satisfactory.
Subject(s)
Humans , Classification , Femur , Follow-Up Studies , Hip Fractures , Retrospective Studies , SkinABSTRACT
PURPOSE: This study examined the clinical course of subtrochanteric fractures of the femur as well as the risk factors of complications. MATERIALS AND METHODS: A retrospective study was performed on 56 patients with femoral subtrochanteric fractures who were treated at our hospital from 2004 to 2008. Risk factors, such as the type of fracture, type of implant, soft tissue dissection at the fracture site, communition of the medial cortex and degree of fracture displacement after the reduction, were compared to determine their effect on the rate of complications, such as nonunion and implant failure. Open reduction with a soft tissue dissection at the fracture site was performed in 34 cases, and a closed reduction was performed in 22 cases. Thirty five cases had medial cortex communition and 21 cases did not. RESULTS: There were 8 cases of nonunion(14.3%). There was a positive correlation between the degree of fracture displacement after the reduction and the union time (P=0.017). The union time was longer when there was communition of the medial cortex. A subtrochanteric fracture using an open reduction tended to have a long union time but this was not statistically significant. There was no correlation between the type of implant and union time. CONCLUSION: The union time is longer in subtrochanteric fractures with communition of the medial cortex. Therefore, it is important to preserve the blood supply at the fracture site using a closed reduction and restore the fracture reduction accurately.