J Korean Fract Soc.  2011 Jul;24(3):223-229.

Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation

• Jung GH

Abstract

PURPOSE
To evaluate the efficiency of provisional K-wire fixation in intertrochanteric fractures treated with proximal femoral nail (PFN).
MATERIALS AND METHODS
Twenty seven patients (by AO/OTA classification, A1 8 cases, A2 19 cases) were treated with PFN with percutaneous reduction and provisional K-wire fixation, and followed a mean 24.5 months. The adequacy of fracture reduction was assessed by Fogagnolo's classification and reestablishment of bone-to-bone contact with the medial anatomy. Functional results were evaluated by postoperative complications, Jensen's method and Harris hip score (HHS).
RESULTS
In all cases, the bone-to-bone contact with the medial anatomy was reestablished by percutaneous reduction and examination of Fogagnolo's classification showed a good reduction. The technical complications and error of starting point were not occurred. The mean HHS was 76.5 and means Jensen's grade was 2.1 grades. Complications included excessive sliding in 1 case and early cutting-out of screw in 1 case.
CONCLUSION
The provisional K-wire fixation in trochanteric fracture treated with PFN had an advantage in preventing technical complications because it facilitates a nail insertion in ideal position.

Keyword

Femur; Trochanteric fracture; Provisional K-wire fixation; Proximal femoral nail

MeSH Terms

Femoral Fractures
Femur
Hip
Hip Fractures
Humans
Imidazoles
Nails
Nitro Compounds
Postoperative Complications
Imidazoles
Nitro Compounds

Figure

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  Fig. 1 Percutaneous reduction technique. (A~C) The medial anatomy was reduced directly by pushing the proximal fragment using the ball-spike instrument. (D, E) A fracture of greater trochanter was percutaneously reduced and fixed with K-wire. (F) The intertrochatneric fracture was provisionally fixed with K-wires. (G~I) The overlap of the head and neck fragment from the shaft was disimpacted using the Langenbeck elevator.

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  Fig. 2 Surgical Technique. (A~C) After percutaneous reduction and provisional K-wires fixation, the reamer for lag screw was firstly inserted to make the entry portal and then, reamer for nail. (D, E) the K-wire was removed during nail insertion. (F, G) After nail insertion, the reduction was lost and provisionally fixed with K-wire for reduction. (H) The lag screw was inserted in deep and central area of femoral head.

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  Fig. 3 Clinical photo revealed the nail insertion through minimal incision after provisional K-wire fixation and percutaneous reduction.

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  Fig. 4 (A) Initial radiographs showed the transverse intertrochanteric fracture. (B, C) The postoperative radiographs showed a good reduction and accurate point of nail insertion but the lag screw was not located in deep area of the femoral head (TAD=37.2 mm). (D) After 7 days, the lag screw was penetrated the femoral head and the fracture was collapsed. (E, F) the lag screw was revised.

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