ABSTRACT
PURPOSE: Nail insertion is the treatment of choice for subtrochanteric femoral fracture, but displacement of proximal bone fragment makes it difficult to find an ideal entry point. Therefore, in this study we aimed to determine the usefulness of treatment of subtrochanteric femoral fracture using Steinmann pin assisted reduction, internal fixation, and insertion of intramedullary nails. MATERIALS AND METHODS: We evaluated 33 patients who were followed-up more than a year with a displaced subtrochanteric femoral fracture treated with closed reduction and intramedullary nail fixation between January 2008 and March 2013. In addition, we studied postoperative bone union time, postoperative reduction status, change of the femur neck shaft angle, evaluation of hip joint function, return to daily life, and complications. RESULTS: All fractures with Steinmann pin assisted reduction were united but they included three cases of delayed union. In Fogagnolo classification, all cases were up to acceptable states and the varus change of femur neck shaft angle was 0.94degrees+/-3.1degrees; no significant difference in Harris hip score was observed between preoperative and last follow-up (p>0.05). CONCLUSION: There were satisfactory results in bone union and reduction state with Steinmann pin assisted reduction. Therefore, Steinmann pin assisted reduction is a useful surgical technique for subtrochanteric femoral fracture.
Subject(s)
Humans , Classification , Femoral Fractures , Femur Neck , Follow-Up Studies , Hip , Hip JointABSTRACT
[Objective]To discuss the feasibility and efficacy of the treatment of low subtrochanteric femoral fracture(LSFF) by using general interlocking intramedullary nail(GIIN).[Method]Between March.2000 and January.2006,47 cases(38 males,9 females) of LSFF were treated with limited incision and 6IIN.The mean age of the patients were 41.2 years(range 25 to 78 years).29 of them were injured in a traffic accident,7 in falling,6 in crush by a heavy object and 5 in pedestrain injury.According to Seinsheimer classification,11 cases were type IA,10 cases were type lB,19 cases were type ⅢB,and 7 cases were type Ⅳ(8 combined with other fractures)6 of these were open fractures(4 cases of Gustilo-Anderson type Ⅰ and 2 cases of type Ⅱ).The procedure included following step: all patients were treated with limited open reduction.The pyriform sinus entry point were localized with retrograde reamed;then,intramedullary nail was performed through the anterograde approach after limited reamed.All fractures were fixed statically.The operation time were from 50 minutes to 130 minutes(averaging 90 minutes).[Result]All the cases,were followed up for 11 to 34 months,with an average time of 33 months.The alignment of fracture was good.The bone union time were 2.5～6 months,the average 3.9 months.Fracture union rate was 100%.The functional evaluation was done by Sanders traumatic hip rating scale.of the 47 cases,31 were excellent,14 good and 11 fair.The excellent and good rate was 95.7%.There were no infection,implant breakage,limb shortening and varus deformity.[Conclusion]In treatment of LSFF,the GIIN is worth to recommend because it is simple for use,no need of X-ray monitoring during the operation,reliable,high union rate,rare complications,and good effects.Reasonable application of GIIN,better fracture reduction and early active functional rehabilitation(earlier activities and later weight bearing) are the keys to obtain a good clinical result.
ABSTRACT
[Objective]To investigate the surgical techniques and clinical result of the treatment of subtrochanteric femoral fracture(SFF) with the reconstruction interlocking nail(RIN).[Method]A total of 40 cases(27 males and 13 females,at age ranged from 22 years to 75 years,mean 43.5 years) with SFF were fixed with RIN in our hospital from June 1998 to May 2005.The fractures were classified according to Seinsheimer,the type Ⅱ 5 cases,type Ⅰ 13,type Ⅳ 21 and type Ⅴ 1.33 patients sustained high-energy injury,and 7 low-energy Three cases were open fractures.[Result]The followed-up period ranged from 8 months to 2 years and 6 months with an average of i year and 8 months.The average time for bony union on xray was 4.2 months (from 3.2 to 6.5 months).According to HAN's scoring system there were 26 excellent cases,12 good cases and 2 fair cases.The excellent and good rate was 95%.There was no severe complications,such as incision infection, fixation failure,deformity or ischemic necrosis of femoral head.[Conclusion]RIN is an effective operation for treatment of SFF.This method has obvious advantages of reliable fixation,few complications and the high bone union rate.Meticulous surgical techniques is the key of success for the operation.