J Korean Fract Soc.  2010 Apr;23(2):227-231. 10.12671/jkfs.2010.23.2.227.

Bursting Fracture of the Proximal Femur during Insertion of Unreamed Femoral Nail for Femur Shaft Fracture: A Case Report

Affiliations
  • 1Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. jjkim2@amc.seoul.kr
  • 2Department of Orthopaedic Surgery, Inje University, Haeundae Paik Hospital, Busan, Korea.
  • 3Samchunpo Seoul Hospital, Samchunpo, Korea.

Abstract

When treating femur shaft fracture in adults, undreamed nail can be an option in order to avoid systemic complications. To appropriately insert unreamed intramedullary nail, an accurate entry point and sufficient reaming of the entry portal is essential. The intramedullary canal of the proximal femur must be reamed over than the diameter of the proximal end of the nail. If the proximal reaming is not sufficient, complications such as bursting fracture of proximal femur can occur. We present two cases of bursting fracture of proximal femur following insertion of undreamed intramedullary nail as well as a literature review.

Keyword

Femur; Femurs shaft fracture; UFN; Complication; Intraoperative fracture

MeSH Terms

Adult
Femur
Humans
Nails

Figure

  • Figure 1 (A) Initial AP view shows AO type A3 femoral shaft fracture and contralateral femoral shaft. (B) Intraoperative C-arm image shows bursting fracture and (C) Bursting fracture is fixed by additional interlocking screw. (D) Postoperative AP and (E) lateral x-rays show union of femoral shaft fracture and bursting fracture.

  • Figure 2 (A) Initial AP view shows AO type B1 femoral shaft fracture. (B) Postoperative AP view, (C) lateral view, (D) preoperative 3D CT image and (E) postoperative 3D CT image show bursting fracture of proximal femur.

  • Figure 3 (A) Postoperative CT shows the appropriate entry point of the nail. (B) Preoperative CT shows 9.8 mm of diameter of the isthmus of the femur. (C) The x-ray shows the level of the following axial images (D~I).

  • Figure 4 The diameter of the most proximal part of the UFN is 13 mm, the diameter of the following portion becomes slender and the diameter of the other part is 9~12 mm.

  • Figure 5 The comparison of proximal reamer for UFN and PFNA. (A) is the proximal reamer for PFNA and the end of PFNA proximal reamer is tapered, and (B) is the proximal reamer for UFN.


Cited by  1 articles

Results of Intramedullary Nailing of Femoral Shaft Fracture - Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail) -
Sang Ho Ha, Woong-Hee Kim, Gwang Chul Lee
J Korean Fract Soc. 2014;27(1):50-57.    doi: 10.12671/jkfs.2014.27.1.50.


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