J Korean Orthop Assoc.  2015 Feb;50(1):8-17. 10.4055/jkoa.2015.50.1.8.

Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail?

Affiliations
  • 1Department of Orthopedic Surgery, VHS Medical Center, Seoul, Korea. 3188yun@naver.com

Abstract

PURPOSE
The purpose of this study is to investigate the constant necessity of distal locking when intertrochanteric fracture was treated with an intramedullary hip nail.
MATERIALS AND METHODS
From April 2010 to June 2013, 47 stable intertrochanteric fractures (AO/OTA 31-A1) were treated with second generation intramedullary hip nailing. They were followed-up for more than 12 months. In the first group of 18 cases distal locking was used, and in the second group of 29 cases, distal locking was not used. We compared the radiologic and clinical results of the two groups.
RESULTS
Comparison of the two groups of patients showed no difference in terms of radiological and functional results. Postoperative thigh pain developed in eight cases (17%). A statistically difference was observed between isthmic diameter and used nail diameter (Fisher exact test, p=0.01) for postoperative thigh pain. In logistic regression analysis, the difference between isthmic diameter and used nail diameter was the most statistically significant factor in development of postoperative thigh pain (p=0.04, odd ratio=27.75).
CONCLUSION
Our results suggested that the second generation intramedullary hip nail may be successfully implanted without distal interlocking in 31-A1 intertrochanteric femur fracture when the reduction status was satisfactory and stable fixation of the distal area was estimated by less than 3 mm difference between isthmic diameter and used nail diameter.

Keyword

femur; intertrochanteric fractures; intramedullary hip nail; distal locking

MeSH Terms

Femur*
Hip Fractures
Hip*
Humans
Logistic Models
Thigh

Figure

  • Figure 1 (A) Preoperative antero-posterior hip radiograph of a 65-year-old male with a 31A1-2 fracture of his left proximal femur. (B) Postoperative radiograph of the patient four weeks after treatment with the intramedullary hip nail with two distal locking. (C) Postoperative radiograph of the patient 24 months after treatment showing union. (D) Preoperative antero-posterior hip radiograph of an 87-year-old male with a 31A1-2 fracture of his left proximal femur. (E) Postoperative radiograph of the patient four weeks after treatment with the intramedullary hip nail without distal locking. (F) Postoperative radiograph of the patient 12 months after treatment showing union.

  • Figure 2 (A) Preoperative anteroposterior hip radiograph of a 79-year-old male with a 31A1-2 fracture of his left proximal femur. (B) Postoperative radiograph of the patient four weeks after treatment with the intramedullary hip nail without distal locking. (C) Postoperative radiograph of the patient three months after treatment showing a visible fracture gap with migration of the nail. (D) Postoperative radiograph of the patient six months after treatment showing a persistent fracture gap. (E) Postoperative radiograph of the patient nine months after treatment showing disappearance of the fracture gap. (F) Postoperative radiograph of the patient 12 months after treatment showing union.

  • Figure 3 (A) Postoperative antero-posterior hip radiograph of a 65-year-old male with a 31A1-1 fracture of his left proximal femur four weeks after treatment with the intramedullary hip nail with two distal locking. (B) Postoperative radiograph of the patient 12 months after treatment showing distal cortical hypertrophy around the locking screw. (C) Postoperative radiograph of the patient four weeks after removal of the nail showing persistent distal cortical hypertrophy. (D) Postoperative radiograph of the patient 24 months after removal of the nail showing decreased distal cortical hypertrophy.

  • Figure 4 (A) Preoperative antero-posterior hip radiograph of an 85-year-old male with a 31A1-1 fracture of his right proximal femur. (B) Intraoperative radiograph of the patient showing inappropriate position of the distal locking screw. (C) Repeated drilling was performed. (D) Postoperative radiograph of the patient 12 months after treatment showing union.


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