J Korean Orthop Assoc.  2015 Feb;50(1):18-24. 10.4055/jkoa.2015.50.1.18.

Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction

• Lee SJ
• Lee SH
• Park SS
• Park HS

• KMID: 2106733
• DOI: http://doi.org/10.4055/jkoa.2015.50.1.18

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.

Keyword

femur subtrochanteric fracture; closed reduction; minimal open reduction; intramedullary long nail

MeSH Terms

Classification
Femur*
Follow-Up Studies
Hip Fractures
Humans
Retrospective Studies
Skin

Figure

• 

  Figure 1 (A) This x-ray shows a subtrochanteric comminuted femur fracture in a 43-year-old male. (B, C) Postoperative radiographs after application of a Sirus® femoral nail with closed reduction. (D, E) Femur anteroposterior and lateral radiographs taken six months after the operation show delayed union. (F, G) Femur anteroposterior and lateral radiographs taken nine months after the operation show bone union in a varus position. (H, I) Femur anteroposterior and lateral radiographs after implant removal.

• 

  Figure 2 (A) This anteroposterior radiograph shows a subtrochanteric femur fracture in a 48-year-old male. (B, C) Postoperative radiographs after application of a Sirus® femoral nail with closed reduction. (D, E) Radiographs taken six months after the operation show nonunion. (F, G) Radiographs taken immediately after the second operation show applied additional plate with autogenous iliac bone graft. (H, I) Bone union was observed at three months after the second operation.

• 

  Figure 3 (A) This x-ray of the femur of a 58-year-old man shows a subtrochanteric femur fracture. (B) Minimal open reduction using a bone holder. (C, D) Postoperative femur anteroposterior and lateral radiographs after application of a MDN® femoral nail. (E, F) Femur anteroposterior and lateral radiographs taken six months after the operation show delayed union. (G, H) Femur anteroposterior and lateral radiographs taken eight months after the operation show bone union in good alignment. (I, J) Postoperative radiographs after implant removal.

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