Hip Pelvis.  2019 Dec;31(4):200-205. 10.5371/hp.2019.31.4.200.

Outcomes of Combined Neck and Trochanter Fractures of the Femur Treated with Cephallomedullary Nail in Elderly

Affiliations
  • 1Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea. femur1973@gmail.com

Abstract

PURPOSE
Proximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients.
MATERIALS AND METHODS
From January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study.
RESULTS
All patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems.
CONCLUSION
Eighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.

Keyword

Femur; Neck and trochanter fracture; Cephalomedullary nail

MeSH Terms

Aged*
Femoral Fractures
Femur*
Follow-Up Studies
Head
Hip
Hip Fractures
Humans
Internal Fixators
Neck*
Retrospective Studies

Figure

  • Fig. 1 Anteroposterior radiographs of 4 part fracture.

  • Fig. 2 (A) Anteroposterior radiograph shows the neck and greater trochanter fracture. (B) Immediate postoperative X-ray shows anatomic reduction for femoral neck fracture. (C) Five year follow-up X-ray shows solid bone union.

  • Fig. 3 (A) Anteroposterior (AP) X-ray shows the basal neck and greater trochanter fracture. (B) Immediate postoperative X-ray shows anatomic alignment on AP view and intra-medullary reduction on lateral view. (C) Immediate postoperative X-ray shows anatomic alignment on AP view and intra-medullary reduction on lateral view. (D) Sixteen months follow-up X-ray shows penetration of blade out of femoral head.


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