J Korean Fract Soc.  2015 Jan;28(1):17-22. 10.12671/jkfs.2015.28.1.17.

Steinmann Pin Assisted Reduction of Subtrochanteric Femoral Fracture

Affiliations
  • 1Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea. wooyasw@gmail.com

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.

Keyword

Subtrochanteric femoral fracture; Fracture reduction techniques; Steinmann pin

MeSH Terms

Classification
Femoral Fractures*
Femur Neck
Follow-Up Studies
Hip
Hip Joint
Humans

Figure

  • Fig. 1 (A) Typical external rotation, abduction, and flexion deformity of the proximal fragment in subtrochanteric fracture. (B-D) Reduction is carried out by Steinmann pin and induction of a guide wire and gradual reaming is performed. (E) Nail insertion and proximal fixation. (F-G) Distal fixation.

  • Fig. 2 Serves as a blocking screw to prevent nail from proceeding anteriorly.


Reference

1. Nikolaou VS, Papathanasopoulos A, Giannoudis PV. What's new in the management of proximal femoral fractures? Injury. 2008; 39:1309–1318.
Article
2. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002; 84:1093–1110.
3. Tornetta P 3rd, Ritz G, Kantor A. Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma. 1995; 38:213–219.
Article
4. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984; 66:529–539.
Article
5. Russell TA, Mir HR, Stoneback J, Cohen J, Downs B. Avoidance of malreduction of proximal femoral shaft fractures with the use of a minimally invasive nail insertion technique (MINIT). J Orthop Trauma. 2008; 22:391–398.
Article
6. de Vries JS, Kloen P, Borens O, Marti RK, Helfet DL. Treatment of subtrochanteric nonunions. Injury. 2006; 37:203–211.
Article
7. Gugenheim JJ, Probe RA, Brinker MR. The effects of femoral shaft malrotation on lower extremity anatomy. J Orthop Trauma. 2004; 18:658–664.
Article
8. Parker MJ, Dutta BK, Sivaji C, Pryor GA. Subtrochanteric fractures of the femur. Injury. 1997; 28:91–95.
Article
9. Siebenrock KA, Müller U, Ganz R. Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury. 1998; 29:Suppl 3. C7–C15.
Article
10. Sims SH. Subtrochanteric femur fractures. Orthop Clin North Am. 2002; 33:113–126. viii
11. Vanderschot P, Vanderspeeten K, Verheyen L, Broos P. A review on 161 subtrochanteric fractures: risk factors influencing outcome: age, fracture pattern and fracture level. Unfallchirurg. 1995; 98:265–271.
12. Nungu KS, Olerud C, Rehnberg L. Treatment of subtrochanteric fractures with the AO dynamic condylar screw. Injury. 1993; 24:90–92.
Article
13. Rohilla R, Singh R, Magu NK, Siwach RC, Sangwan SS. Mini-incision dynamic condylar screw fixation for comminuted subtrochanteric hip fractures. J Orthop Surg (Hong Kong). 2008; 16:150–155.
Article
14. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res. 1989; (238):122–130.
15. Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect. 1995; 44:227–253.
Article
16. Asher MA, Tippett JW, Rockwood CA, Zilber S. Compression fixation of subtrochanteric fractures. Clin Orthop Relat Res. 1976; (117):202–208.
Article
17. Trafton PG. Subtrochanteric-intertrochanteric femoral fractures. Orthop Clin North Am. 1987; 18:59–71.
Article
18. Krettek C, Miclau T, Schandelmaier P, Stephan C, Möhlmann U, Tscherne H. The mechanical effect of blocking screws (Poller screws) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma. 1999; 13:550–553.
Article
19. Krettek C, Stephan C, Schandelmaier P, Richter M, Pape HC, Miclau T. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br. 1999; 81:963–968.
Article
20. Stedtfeld HW, Mittlmeier T, Landgraf P, Ewert A. The logic and clinical applications of blocking screws. J Bone Joint Surg Am. 2004; 86:Suppl 2. 17–25.
Article
21. Seyhan M, Unay K, Sener N. Comparison of reduction methods in intramedullary nailing of subtrochanteric femoral fractures. Acta Orthop Traumatol Turc. 2012; 46:113–119.
Article
22. Park J, Yang KH. Correction of malalignment in proximal femoral nailing--Reduction technique of displaced proximal fragment. Injury. 2010; 41:634–638.
Article
Full Text Links
  • JKFS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr