Hip Pelvis.  2017 Jun;29(2):113-119. 10.5371/hp.2017.29.2.113.

Clinical Results of Complex Subtrochanteric Femoral Fractures with Long Cephalomedullary Hip Nail

  • 1Department of Orthopaedic Surgery, College of Medicine, Konyang University, Daejeon, Korea. yougunwon@gmail.com, ywon@bidmc.harvard.edu
  • 2Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.
  • 3Changwon Fatima Hospital, Changwon, Korea.


Good results of the cephalomedullary nails have been reported in proximal femoral fractures recently. Based on length of nails and shape of screws fixed in a femoral head for proximal fragment fixation, the proper nail length was in dispute. The purpose of this study was to evaluate the clinical and radiological results of a long cephalomedullary hip nail for the treatment of comminuted subtrochanteric femoral fractures.
Twenty-one consecutive patients with severe subtrochanteric femoral fractures who had undergone intramedullary fixation using long-PFNA II between March 2010 and March 2013 were followed-up for over 12 months. Their mean age was 64.8 years old (range, 43-85 years). Sixteen of 22 cases were high energy trauma. According to Seinsheimer's classification, 5 cases were type IV and 16 cases were type V. For radiological assessment, time to union, change of neck-shaft angle, sliding length, tip-apex distance (TAD) and leg length discrepancy (LLD) were measured. For clinical evaluation, a modified Koval index was investigated.
Mean operation time was 96 minutes. An average decrease of neck-shaft angle was 4.5°. The average sliding length of the helical blade was 4.2 mm. Average LLD was 3.0 mm, and TAD was 23.0 mm. Mean modified Koval index score at final follow-up was 4.6 points. All the 21 subtrochanteric fractures healed uneventfully on an average of 24.2 weeks (range, 18-30 weeks).
Long cephalomedullary hip nail provides excellent clinical and radiological outcomes in the comminuted subtrochanteric fracture.


Femur; Subtrochanteric fracture; Long cephalomedullary hip nail
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