J Korean Fract Soc.  2011 Oct;24(4):301-306.

The Treatment of Subtrochanteric Fracture with Cephallomedually Nail: Minimal Incision and Lowman Clamp Assisted Reduction

• Choi JS
• Moon DH
• Noh YT

Abstract

PURPOSE
To evaluate the radiographic results of patients with subtrochanteric femoral fracture using minimal incision and cephalomedullary nail technique.
MATERIALS AND METHODS
This study was performed on 54 patients, 54 cases of hip, recruited among patients who underwent minimal incision and Cephalomedullary nail from September 2005 to August 2008 and were available for 1-year or longer follow up. The gender ratio was 37 males and 17 females, and the mean age at the time of surgery was 57.4 years (range; 16~81 years). According to injury mechanism, traffic accident was 29 cases, fall down form high height was 18 cases, slip down was 7 cases. In classification by Seinsheimer, type II was 23 cases (m/c), type III was 18 cases, type IV was 13 cases. Average follow up period was 14 months (12~18). Radiographic evaluation was performed for time taking union, mal-union and complication.
RESULTS
53 of the 54 cases united. 39 of 54 reductions were anatomic. 19 fractures had a monir varus deformity of proximal fragment (between 2degrees and 5degrees). There was no varus deformity of more than 5degrees. 1 case that had been treated with PFN had nail breakage without trauma. There were no other complications.
CONCLUSION
Surgical treatment of subtrochanteric fractures with minimal incision and Cephalomedullary nail technique can reslut in excellent reduction without complications including inflammation & malunion. Careful attention to detail for using Lowman clamp is demanding to decrease soft tissue injury.

Keyword

Subtrochanteric femoral fractures; Minimal incision & cephalomedullary nail; Lowman clamp

MeSH Terms

Accidents, Traffic
Congenital Abnormalities
Female
Femoral Fractures
Follow-Up Studies
Hip
Hip Fractures
Humans
Inflammation
Male
Nails
Soft Tissue Injuries

Figure

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  Fig. 1 Surgical technique. (A) Temporary fixation by using Lowman clamp. (B) Nail insertion & screw fixation through previous proximal incision site.

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  Fig. 2 Result after surgical treatment using PFN. (A) Pre-operative X-ray shows Seinsheimer type IV subtrochanteric fracture. (B) Radiograph at 6-months after surgery shows solid bony union.

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  Fig. 3 (A) Radiograph at 3-months after surgery shows breakage of metal implant. (B) Reoperation using a blade plate at 6-months after interlocking intramedullary nailing.

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