Journal of Musculoskeletal Trauma

Risk Factors of Fixation Failure in Femoral Neck Fractures: Sung Hyun Yoon, Kyu Beom Kim, Hyung Jun Lee, Kyung Wook Kim; J Korean Fract Soc 2023;36(4):118-124. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.118

Abstract PDF: Purpose
Internal fixation after a femoral neck fracture (FNF) is one of the conventional treatment options for the young and active elderly patients. However, fixation failure of internal fixation is a probable complication. The treatment of fixation failure after a primary internal fixation of the FNF remains a challenge.
Materials and Methods
Between July 2002 and March 2017, 83 patients who underwent internal fixation after FNF were retrospectively analyzed. Radiological assessments, including Pauwels’ angle, fracture level, reduction quality, and bone union, were measured, preoperatively and postoperatively. Moreover, intraoperative variables such as time to surgery, surgical time, and estimated blood loss were also evaluated.
Results
The patients were divided into the fixation failure and the non-failure groups. Among the 83 patients, 17 cases (20.5%) of fixation failure after the primary internal fixation of the FNF were identi-fied. When comparing the two groups according to the radiographic data, Pauwels’ angle and the reduction quality based on Garden’s angle showed significant differences (p<0.001). Moreover, when comparing the intraoperative variables, unlike the surgical time and estimated blood loss, significant differences were noted in the time interval from injury to surgery and specifically in whether the surgery was performed within 12 hours after injury (p<0.001).
Conclusion
Pauwels’ angle, reduction quality, and time to surgery are the major factors that can predict the possibility of internal fixation failure of the FNF. Early and accurate anatomical reduction is needed to decrease complications after the internal fixation of the FNF.

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Recurrent Treatment Failure in Vancouver Classification Type C Periprosthetic Fractures around a Well Fixed Short Femoral Stem: Byeong Yeol Choi, Hong-Man Cho, Jiyeon Park; J Korean Fract Soc 2022;35(1):16-20. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.16

Abstract PDF: A short femoral stem (type 1 cementless stem) is being increasingly used to perform total hip arthroplasty; however, various types of intra- or postoperative periprosthetic fractures have been reported in recent times. A 66-year-old woman with a history of bilateral total hip arthroplasties using a type 1B femoral stem was admitted 2 months post-operation for a Vancouver type C periprosthetic fracture. She underwent open reduction and internal fixation; however, we observed recurrent non-union and plate breakage at the same site. In this case report, we discuss the factors associated with treatment failure in patients with a Vancouver type C periprosthetic fracture following type 1 femoral stem im-plantation.

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Treatment of Proximal Femur Fracture with a Newly Designed Nail: Trochanteric Fixation Nail-Advanced (TFNA): Jae Youn Yoon, Ji Wan Kim; J Korean Fract Soc 2020;33(4):189-195. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.189

Purpose
This study evaluated the clinical results and implant safety of a newly developed implant, Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes), in the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective cohort study of 26 patients diagnosed with proximal femur fracture and treated surgically with TFNA. The patients’ demographic data, surgical data, radiologic findings, and functional outcomes, including complications, were evaluated.
Results
The mean age of the patients was 71.2 years (95% confidence interval [CI], 68.2-74.2); 65.4% were female. The mean Carlson comorbidity index score was 5.4, and the mean Koval grade before fracture was 2.1. Fracture classification included four cases of AO/OTA 31.A1, nine cases of A2, six cases of A3, and seven cases of 32A including six cases of atypical femoral fractures. The mean operating time was 53.3 minutes (95% CI, 43.6-63.1). There were no early postoperative complications, such as postoperative infection, deep vein thrombosis, pulmonary embolism, or in-hospital death, except one case of pneumonia. The mean Koval score at the postoperative six-month follow-up was 2.9. EuroQol-5 Dimension (EQ-5D) increased from 0.05 to 0.54 after three months and 0.72 at six months postoperatively. Bone union was observed in all cases with a mean union time of 12.9 weeks. No implant failure occurred, and no cases required secondary revision surgery.
Conclusion
A new intramedullary nail system, TFNA, showed excellent outcomes and safety in the surgical treatment of proximal femur fractures.

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Intermediate Length Cephalomedullary Nails in Proximal Femoral Fractures: Review of Indications and Outcomes
Daniel Scott Horwitz, Ahmed Nageeb Mahmoud, Michael Suk
Journal of the American Academy of Orthopaedic Surgeons.2025;[Epub] CrossRef
Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain
Sung Yoon Jung, Myoung Jin Lee, Lih Wang, Hyeon Jun Kim, Dong Hoon Sung, Jun Ha Park
Journal of the Korean Orthopaedic Association.2024; 59(3): 208. CrossRef
Prospective randomized multicenter noninferiority clinical trial evaluating the use of TFN-advancedTM proximal femoral nailing system (TFNA) for the treatment of proximal femur fracture in a Chinese population
Lidan Zhang, Zhijun Pan, Xiaohui Zheng, Qiugen Wang, Peifu Tang, Fang Zhou, Fan Liu, Bin Yu, Frankie K. L. Leung, Alex Wu, Suzanne Hughson, Zhuo Chen, Michael Blauth, Anthony Rosner, Charisse Sparks, Manyi Wang
European Journal of Trauma and Emergency Surgery.2023; 49(3): 1561. CrossRef
Risk of shortening in operatively treated proximal femur fractures with cephalomedullary nails with dynamically versus statically locked helical blades
Nathan Cherian, Lasun Oladeji, Cole Ohnoutka, Dan Touhey, Madeline Sauer, Kyle A. Schweser, Mauricio Kfuri, James L. Cook, Gregory J. Della Rocca, Brett D. Crist
Injury.2023; 54(2): 669. CrossRef
GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures
Seungcheol Kwon, Minjae Lee, Heeyeon Lee, Jihyo Hwang
Journal of Clinical Medicine.2023; 12(21): 6720. CrossRef
Comparison of the Clinical and Radiological Outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) Treatment in Elderly Patients with Intertrochanteric Fractures
Min Sung Kwon, Young Bok Kim, Gyu Min Kong
Journal of the Korean Fracture Society.2022; 35(4): 162. CrossRef
Analysis of Clinical and Functional Outcomes according to the Blood Sugar Control Status at the Time of Ankle Fractures Resulting from Rotational Injuries
Jun Young Lee, Dong Seop Lim, Seung Hyun Lee, Seo Jin Park
Journal of the Korean Fracture Society.2022; 35(4): 135. CrossRef
Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation
Hong Man Cho, Kwang Min Park, Tae Gon Jung, Ji Yeon Park, Young Lee
BMC Musculoskeletal Disorders.2021;[Epub] CrossRef
Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee
Journal of the Korean Fracture Society.2021; 34(3): 105. CrossRef

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The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture: Hee Gon Park, Yong Eun Shin, Sung Hyun Kim; J Korean Fract Soc 2017;30(1):9-15. Published online January 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.1.9

Abstract PDF

PURPOSE
A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial.
MATERIALS AND METHODS
Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author.
RESULTS
The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p<0.05). In particular, the presence of impacted fracture fragment in the hip joint and large size of the impacted fracture fragment was highly related to the failure of second closed reduction trial requiring open reduction. Conversely, the method of reduction, Thompson-Epstein classification, Pipkin classification were not related to the failure of closed reduction statistically (p>0.05).
CONCLUSION
To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.

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Traumatic obturator dislocation of the hip joint: About 2 cases and review of the literature
Z.F. Zengui, O. El Adaoui, M. Fargouch, O. Adnane, Y. El Andaloussi, M. Fadili
International Journal of Surgery Case Reports.2022; 93: 106983. CrossRef

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Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture: Joon Soon Kang, Ryuh Sup Kim, Bom Soo Kim, Young Tae Kim, Seung Hyun Hong; J Korean Fract Soc 2012;25(4):263-268. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.263

Abstract PDF: PURPOSE
To analyze the causes of internal fixation failure in elderly intertrochanteric femoral fractures.
MATERIALS AND METHODS
We retrospectively analyzed 93 intertrochanteric femoral fractures that were treated by internal fixation. The follow-up period was at least 24 months. The mean age was 73 years. We analyzed the classification of the fracture, screw position, reduction state of the fracture, and neck-shaft angle.
RESULTS
Internal fixation failure occurred in 12 cases (12.9%). The causes of internal fixation failure were one case (1.0%) of head perforation, 7 cases (7.5%) of excessive slippage of a screw, and 4 cases (4.3%) of varus deformity. Significant factors infixation failure were displacement of the posterolateral fragment more than 8 mm in anteroposterior radiograph, anterior displacement of a fragment, or more than 20-degree angulation in lateral radiography. Thirty-three cases had a screw in the middle position and 4 of these cases (12.1%) had fixation failure. Notably, 14 cases had a screw in the posteromedial position and 6 of these cases had fixation failure (42.8%).
CONCLUSION
Accurate reduction of the posteromedial fragment is essential in unstable intertrochanteric fracture and anterior displacement or angulation should be avoided to prevent fixation failure. The tip apex distance of the screw and central location of the screw in the femoral head is also an important factor.

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Analysis of the Fixation Failure in Intertrochanteric Hip Fractures Treated with Hip Nailing: Jun Dong Chang, Tae Young Kim, Ji Hyo Hwang, Seul Ki Min, Je Hyun Yoo; J Korean Fract Soc 2012;25(3):169-176. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.169

Abstract PDF

PURPOSE
To analyze the patterns of and risk factors for fixation failure after hip nailing in intertrochanteric (IT) hip fractures.
MATERIALS AND METHODS
Fourteen patients who sustained a fixation failure after hip nailing for IT hip fractures were enrolled in this study. The mean age at the index surgery was 74.5 years and the mean time to the fixation failure was 6.6 weeks. All of the serial radiographs up to the fixation failure and pre-operative 3-D computed tomography were analyzed.
RESULTS
According to AO classification, there were 7 stable fractures and 7 unstable ones. Of the total of 14 cases, 10 showed a comminution of the greater trochanter tip and incomplete anatomical reduction of the medial and anterior cortex at the fracture site. Of the 10 cases with appropriate position of the lag screw within the femoral head, 9 showed a high pertrochanteric fracture (HPF) pattern. The mechanism of the fixation failure was rotation of the femoral head in 7 of 9 cases with HPF and varus collapse of the proximal fragment in 4 of the other 5 cases.
CONCLUSION
The HPF pattern, the comminution of the greater trochanter tip, and incomplete reduction of the medial and anterior cortex may be additional risk factors of fixation failure after treating IT hip fractures with hip nailing in.

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Unstable Intertrochanteric Fracture Treated with ITST: A Comparative Study between Groups with and without Comminution of Greater Trochanter
Kyung-Sub Song, Sang-Ho Lee, Seong-Hun Jeong, Su-Keon Lee, Sung-Ha Hong
Journal of the Korean Fracture Society.2014; 27(1): 36. CrossRef

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Failure of Removal of Stripped Locking Screw after Locking Compression Plating: Sung Jin Kim, Kyung Jae Lee; J Korean Fract Soc 2011;24(2):169-173. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.169

Abstract PDF

PURPOSE
The purpose of this study was to evaluate the incidence and possible causes of stripped locking screws that make difficult to remove the locking compression plate. We also tried to find the useful methods to remove the stripped locking screws.
MATERIALS AND METHODS
Between May 2005 and January 2009, 84 patients who underwent operations for removal of locking compression plate were included in this study. We removed 298 3.5-mm locking screws and 289 5.0-mm locking screws in these patients. We retrospectively investigated the incidence and possible causes of stripped locking screws and evaluated the pros and cons of the methods that we have used to remove the stripped locking screws.
RESULTS
17 out of 298 3.5-mm locking screws (5.7%) and 2 out of 289 5.0-mm locking screws (0.7%) were encountered with difficulties by hexagonal driver during removal because of the stripping of the hexagonal recess. First we used the conical extraction screw for all the stripped locking screws and only 3 screws were removed successfully. We removed 3 screws by cutting the plate around the stripped locking screw and twisting the plate with the screw and we removed 1 screw by the use of hallow reamer after cutting the plate. Twelve screw shafts were left except grinding of screw head by metal-cutting burr. There was one iatrogenic re-fracture in whom we have used with hallow reamer.
CONCLUSION
At the time of locking compression plate removal, difficulties of locking screw removal due to the stripping of the hexagonal recess should be expected and surgeon must prepare several methods to solve this problem.

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An inexpensive and rapid method for removal of multiple stripped locking screws following locking plating: A case report
Won Ro Park, Jae Hoon Jang
International Journal of Surgery Case Reports.2019; 57: 134. CrossRef

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Analysis of Affecting Factors of Fixation Failure of Femoral Neck Fractures Using Internal Fixation: Soo Jae Yim, Seung Han Woo, Min Young Kim, Jong Seok Park, Eung Ha Kim, Yoo Sung Seo, Byung Il Lee; J Korean Fract Soc 2006;19(3):297-302. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.297

Abstract

PURPOSE
To evaluate the factors which influence on the fixation failure after internal fixation using multiple cannulated screws in the patients with femoral neck fracture.
MATERIALS AND METHODS
Ninty-six patients (male: 63, female: 33) who underwent closed reduction and internal fixation of femoral neck fracture between Feb. 1994 and Jun. 2002 with use of multiple cannulated screws. The mean age was 68 years (17~90) and mean follow-up period was average 50 months (36 months~6 years). The fixation failure was defined by change in fracture position above 10 mm, change in each screws position above 5%, backing above 20 mm, or perforation of the head, respectively. They were evaluated with the age, gender, fracture type, accuracy of reduction, placement of screws, posterior comminution and also studied the risk factors which influenced nonunion and the development of avascular necrosis.
RESULTS
Twenty-four patients out of 96 patients had radiographic signs of fixation failure. The incidence of nonunion in the fixation failure group was 41% (10/24) and AVN was 33% (8/24). There were statistically significant correlations between fixation failure and nonunion and that posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion.
CONCLUSION
In case of femoral neck fracture of internal fixation using multiple cannulated screws, posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion and fixation failure.

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Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures
Joon Soon Kang, Kyoung Ho Moon, Joong Sup Shin, Eun Ho Shin, Chi Hoon Ahn, Geon Hong Choi
Clinics in Orthopedic Surgery.2016; 8(2): 146. CrossRef
Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years
Ui-Seoung Yoon, Jin-Soo Kim, Hak-Jin Min, Jae-Seong Seo, Jong-Pil Yoon, Joo-Young Chung
Journal of the Korean Fracture Society.2010; 23(1): 1. CrossRef
Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures
Tae-Ho Kim, Jong-Oh Kim, Sung-Sik Kang
Journal of the Korean Fracture Society.2009; 22(2): 79. CrossRef

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Fixation Failure of LCP during the Treatment of Proximal Humerus Fractures: Woo Kie Min, Sang Jin Sin, In Ho Jeon, Ki Bong Cha, Chang Wuk Oh, Poong Taek Kim, Sang Ho Cheon; J Korean Fract Soc 2006;19(2):188-192. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.188

Abstract

PURPOSE
To evaluate the causative factors in the catastrophic failure of LCP in the proximal humerus fracture.
MATERIALS AND METHODS
Six patients (6 cases) were collected between October 2003 and July 2005. The mean age was 55.6 years (range: 38~70). The cause of injury was road traffic accident in four, fall down in one and slip down in one. According to the Neer classification, four were 2 part fractures, each one in 3 part fracture and 4 part fracture.
RESULTS
Fixation failure occurred due to back-out of the plate and screw in five and plate breakage in one. Analysis of the preoperative radiographs revealed medial cortical defect in all and no bone graft and tension band wiring in the greater tuberosity fragment were carried out. Postoperative radiographs showed the anatomical reduction in three and non-anatomical in three.
CONCLUSION
Non-anatomical reduction, insufficient medial bony buttress, inadequate screw length to the head and the neglect for the greater tuberosity fragment were the contributing factors to the failure of LCP. Knowledge of these factors will enable the surgeon to avoid failure of the LCP. Augmentation fixation and bone graft procedures with careful preoperative planning are necessary for successful fixation of LCP.

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The Result of Conservative Treatment of Proximal Humerus Fracture in Elderly Patients
Seung-Gil Baek, Chang-Wug Oh, Young-Soo Byun, Jong-Keon Oh, Joon-Woo Kim, Jong-Pil Yoon, Hyun-Joo Lee, Hyung-Sub Kim
Journal of the Korean Fracture Society.2013; 26(4): 292. CrossRef
A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus
Sung-Weon Jung
Journal of the Korean Fracture Society.2013; 26(1): 8. CrossRef
Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years
Ki Won Lee, Young Joon Choi, Hyung Sun Ahn, Chung Hwan Kim, Jae Kwang Hwang, Jeong Ho Kang, Han Ho Choo, Jun Seok Park, Tae Kyung Kim
Clinics in Shoulder and Elbow.2012; 15(1): 25. CrossRef
Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture
Jin-Oh Park, Jin-Young Park, Sung-Tae Lee, Hong-Keun Park
Journal of the Korean Fracture Society.2007; 20(1): 45. CrossRef

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Fixation Failure of Unstable Intertrochanteric Fracture of the Femur Using Compression Hip Screw: Sang Won Park, Soon Hyuck Lee, Jong Ryoon Baek, Sung Jun Park, Jong Won Chung; J Korean Fract Soc 2005;18(1):1-5. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.1

Abstract PDF: PURPOSE
To investigate the factors which influence on the fixation failure after the compression hip screw fixation for unstable intertrochanteric fractures.
MATERIALS AND METHODS
Eighty-two patients of unstable intertrochanteric fracture of A2 and A3 type who had underwent operation with compression hip screw were evaluated at least 1 year follow-up in regard to the age, degree of osteoporosis, fracture type, diastasis of fragment, sliding of lag screw, position of lag screw and status of reduction.
RESULTS
73 patients out of 82 patients had the union and 9 patients showed fixation failure. The results of fixation failure were 6 cases of migration of lag screw and 3 cases of cut-out of lag screw. There were statistically significant correlations between fixation failure and A2.3 and A3 type. The fixation failure group showed increased medial migration of medial cortex of proximal and distal fragment, which is significantly correlated with fixation failure. There were little statistical significant correlations between age, degree of osteoporosis, status of reduction, position of lag screw, sliding of lag screw and fixation failure.
CONCLUSION
Another alternative fixation method and technique have to be considered for unstable A2-3 or A3 type because compression hip screw fixation only is very insufficient with high failure rate.

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Fixation Failure of Compression Hip Screw in Unstable Intertrochanteric Fracture of Femur: Deuk Soo Hwang, Sang Goo Kwak, Young Mo Kim, Dae Chul Nam, Ui Pyo Hong; J Korean Soc Fract 2003;16(4):600-604. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.600

Abstract PDF

PURPOSE
To evaluate the factor of fixation failure in association of the early controlled weight bearing exercise after using a compression hip screw (CHS) for unstable intertrochanteric fracture of femur in old ages.
MATERIALS AND METHODS
Between May 1998 and February 2002, 8 cases of fixation failure of CHS among the 80 patients were evaluated. We compared gender, age, fracture type with a matched group that fixation failure was not noted. During operation, we performed valgus nailing of compress lag screw and compressed fracture gap with a bolt as soon as possible. The patients were encouraged partial weight bearing 4~5 days after operation and compaired immediate postoperative and postoperative 2 weeks x-ray films about degree of slippage or varus angulation of femur.
RESULTS
In 5 cases, cut-out of the lag screw were found. In 3 cases, plate fracture and fixation failure were found. Relation between timing of partial weight bearing and fixation failure was not significant (p=0.146). But in 5 cases of failure, they continued weight bearing in spite of excessive slippage of the lag screw.
CONCLUSION
Early controlled partial weight bearing exercise after operation of intertrochanteric fracture of the femur were reported good for functional recovery in old ages. But, excessive slippage of the lag screw or varus angulation of proximal femur were found on follow up period, patient teaching and control of ambulation is strongly recommended.

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Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients
Soon-Yong Kwon, Hyun-Woo Park, Sang-Uk Lee, Soo-Hwan Kang, Jae-Young Kwon, Jung-Hoon Do, Seung-Koo Rhee
Journal of the Korean Fracture Society.2008; 21(4): 267. CrossRef

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Analysis of Failures of Union of the Intertrochanteric Femoral Fractures: Sung Soo Kim, Sung Keun Sohn, Myung Jin Lee, Min Soo Kang, Sang Kook Kim; J Korean Soc Fract 2003;16(4):456-464. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.456

Abstract PDF

PURPOSE
The purpose of this study was to analyze the factors influencing the failure of union in the intertrochanteric femoral fractures.
MATERIALS AND METHODS
Authors divided the patients treated with lag screws into two groups, 9 cases of the non-union group and 46 cases of the union group. And analyzed the preoperative, intraoperative and postoperative factors influencing the union.
RESULTS
Age, displacement in AP film after surgery, displacement of lesser trochanter after surgery, superior or anterior position of lag screw, displacement of lag screw and change of neck-shaft angle were significantly higher in the non-union group. Displacement in AP radiograph after surgery and displacement of lag screw were two significant factors by multivariate logistic regression analysis.
CONCLUSION
In case of intertrochanteric fracture treated with lag screw, the probabilities of union failure are increased when the displacement is more than 5 mm in AP plane postoperatively and the sliding of lag screw is more than 10 mm in follow-up.

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Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews
So Young Kim
Journal of the Korean Fracture Society.2019; 32(2): 89. CrossRef
Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients
Soon-Yong Kwon, Hyun-Woo Park, Sang-Uk Lee, Soo-Hwan Kang, Jae-Young Kwon, Jung-Hoon Do, Seung-Koo Rhee
Journal of the Korean Fracture Society.2008; 21(4): 267. CrossRef

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Common Modes of Fixation Failure with a Sliding Hip Screw encountered Unstable Intertrochanteric Fracture: Byung Soon Kim, Duck Yun Cho, Hyung Ku Yoon, Dong Eun Sin, Soo Hong Han, Jae Hwa Kim, Dong Jun Kim; J Korean Soc Fract 2003;16(1):15-21. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.15

Abstract PDF

The purpose of this study was to evaluate the common modes of fixation failure in unstable intertrochanteric fractures , related risk factors and the prevention of fixation failure. Between 1995 and 2001, 44 patients who had sustained an unstable intertrochanteric fractures were assigned to be treated with a sliding hip screw. Men in 14 cases ( 32% ), women in 30 cases ( 68% ) , the average age at the operation was 65(22-90) years and the average duration of follow up was 12(8-22) months. We classified the fracture patterns with Evans system and used Singh 's index for osteoporosis. And we examined the common modes of fixation failure with postoperative X-ray. The fixation failure in unstable intertrochanteric fracture was 8 cases (18.2 % ); varus collapse of the proximal fragment with cutout of the lag screw was 3 cases (6.8%), varus collapse of the proximal fragment with excessive sliding of the lag screw was 4 cases (9.1%) and loss of fixation of the plate-holding screws was 1 case (2.3%). The authors think that inadequate anatomical reduction of comminuted posteromedial fragment and severity of osteoporosis are main causes of fixation failure. During operation for unstable intertrochanteric fractures, the most important point is accurate reduction of posteromedial fragment and the intramedullary hip screw like proximal femoral nail ( PFN ) may be considered to avoid fracture of lateral cortex that enter the lag screw, causing fixation failure.

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The Antero-medial Cortex Overlapped Reduction of Unstable Intertrochanteric Fractures
Chae-Geun Kim, Suc-Hyun Kweon, Hong-Jun Han, Jae-Seon Hwang
Hip & Pelvis.2013; 25(4): 280. CrossRef

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Metal Failure after Internal Fixation in the Treatment of Femur Mid-shaft Fractures: Kyung Jin Song, Jang Yeub Jeon, Jin Ho Yoon, Myung Sik Park, Byung Yeon Hwang; J Korean Soc Fract 2002;15(3):349-355. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.349

Abstract PDF: PURPOSE
To evaluate the causative factors of metal failure after internal fixation, and to suggest more rational treatment guideline that can prevent metal failure in the mid-shaft femur fractures.
MATERIALS AND METHODS
A retrospective review of 17 cases, who were treated with internal fixation for the femur mid-shaft fracture was analyzed. We evaluated the cause of injury, fracture type and site, associated injury, used instruments, duration to metal failure, and complications.
RESULTS
The metal failure occurred on average 14.8 months after internal fixation. As extrinsic factors, early exercise and weight-bearing in 7 cases, slip down during ambulation in 4 cases, improper physical therapy in 3 cases and unknown cause in 3 cases were related to metal failure. Most metal failure were occurred at the initial fracture site in 12 cases. Other metal failure site were empty holes in 1 case and proximal area of fracture site in 1 case, and screw breakage in 3 cases.
CONCLUSION
Accurate preoperative evaluation of fracture site, fracture type and proper selection of instrument, and precise surgical technique will be essential for the prevention of metal failure.

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Treatment of Trochanteric Fractures of the Femur with Compression Hip Screw-Analysis of Factors associated with Failure of Fixation-: Chan Hoon Yoo, Hong Tae Kim, Young Soo Byun, Jun Mo Nam, Young Ho Cho, Seong Gun Moon; J Korean Soc Fract 2002;15(3):312-319. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.312

Abstract PDF: PURPOSE
This study was performed to analyze the significant factors that may affect failure of fixation in trochanteric fractures of the femur treated with the compression hip screw.
MATERIALS AND METHODS
From May 1995 to July 2000, the authors analyzed 97 cases of trochanteric fracture of the femur treated with the compression hip screw and followed more than one year. We classified the fracture type by Jensen 's method. We used Singh index for the degree of osteoporosis. In the post-operative radiograph, we checked neck-shaft angle, state of reduction, position of the lag screw within the femoral head, tip-apex distance, and sliding distance of the lag screw. The relationship between these factors and failure of fixation was statistically analyzed.
RESULTS
There were 17 cases (17.5%) of failure of fixation ; 15 cases (15.4%) of excessive sliding of the lag screw, 1 case (1%) of cutting out of the lag screw, and 1 case (1%) of valgus malunion. There were significant relationships between failure of fixation and old age over 80, unstable fracture, telescoping reduction, anterior or medial displacement of the distal fragment, and anterior placement of the lag screw within the femoral head.
CONCLUSION
Accurate reduction and avoidance of the placement of the lag screw in the anterior part of the femoral head were important factors to prevent failure of fixation in trochanteric fractures of the femur treated with the compression hip screw.

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Metal failure after compression plate fixation in femoral shaft fracture: Sung Ho Han, Bo Kyu Yang, Chi Hong Kim, Tae Won Ahn, Dong Hyun Kim; J Korean Soc Fract 1998;11(4):732-737. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.732

Abstract PDF: Intramedullary nailing is one of the most available method in the treatment of femoral shaft fracture. Recemtly compression plate is not widly used. Inapproriate technique using compression plate lead to metal failure. The purpose of this study is to analyz the clinical feature, cause and treatment of metal ailure in femoral shaft fracture. We analyzed 6 cases of metal failure from Jan. 1990. to Dec. 1996 and obtained the following results. 1. Type of fracture were Winquist-Hansen Type I in 1 case, Type-II 3 cases, Type III 2 cases. 2. The interval between initial poeration and metal failure was 11 months on average, ranging from one to twenty months. 3. Metal failure occurred as plate breakage in 4 cases, plate bending and loosening in 2 cases. 4. Cause of metal failure after compression plate fixation presumed to be comminuted fracture in 5 cases, early weight bearing in 3 cases, remaining bone defect in 4 cases, inadequate surgical technique in 4 cases and empty plate hole in 4 cases. 5. Treatment of metal failure after compression plate fixation were intramedullary nailing with bone graft in all cases. Accturate preoperative evaluation of fracture site, fracture pattern, and appropiate selection of metal device necessary for the prevention of metal failure.

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Analysis of Metal Failures for the femur Shaft Fractures: Kyung Jin Song, Hwang Jik Kim, Jeong Ryul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(3):501-508. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.501

Abstract PDF: The purpose of this investigation was to analyze the causes of the metal failures, and to suggest reasonable methods that can prevent metallic failures in the treamtnet of femur shaft fractures. There were 27 metal failures in 25 patient who underwent internal fixation for the femur shaft fracture between May of 1990 and May of 1996. We analyzed the causes of injury, fracture site, associated injury and used implants for the femur shaft fractures. And also analyzed the interval since operation to metal failure, method of treatment, and complications following surgery for the metallic failures. There were 13 stainless steel DCP(dynamic compression plate), 4 titanium LC(low contact)-DCP, 7 interlocking IM(intramedullary) nails, 2 Dutscher nails, and 1 anatomical plate. The metal failure occurred on average 6.1 months after internal fixation. Eight stainless steel DCP, 4 LC0DCP and 1 anatomical plate failed at the empty hole located at the fracture site. With interlocking IM nail, 4 cases of failure occurred at the proximal 1/3 of femur and other 3 cases showed failure on distal interlocking hole in distal femoral shaft fractures. All failures developed at the fracture site in kuntscher nail. For the treatment of metal failures, we used stainless steel DCP in 12 cases, interlocking IM nail in 7 cases, Kuntcher nail in 2 cases, Ender nail in 1 case, dual plate in 1 case, and external fixation in 2 cases. Autogenous cancellous iliac bone graft applied in 20 cases for the augmentation of frcture site or to fill the defect area. There were 2 cases of re-failure, 2 chronic osteomyelitis, 1 fracture site infection, 2 delayed union and knee joint ankylosis in 1 case. Accurate preoperative evaluation of fracture site, fracture pattern and proper implant selection will be essential for the prevention of metal failures. Minimal soft tissue dissection, anatomical reduction and rigid internal fixation will be necessary for the satisfactory outcome in the treatment of femur shaft fractures. Augmentation with autogenous cancellous bone graft should be followed after internal fixation for the comminuted fractures or bony defect over the fracture site. Postoperative rehabilitation program should be individualized according to the preoperative fracture pattern, used implant, and fracture stability.

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Metal Failure after Plate Fixation for Femur Fracture: Hee Kwon, Dong Wook Kim, Chi Soo Sohn, Seung Ryeol Yoon, Joon Min Song, Soo Kyoon Rah, Chang Uk Choi; J Korean Soc Fract 1997;10(2):371-378. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.371

Abstract PDF

From January 1991 to August 1996, we experienced 17 cases of metal failure among 150 cases of plate fixation of femur fracture. We analyzed the cases and obtained the following results: 1. Among 17 cases, 15 cases were closed fracture and 2 cases were open fracture. In 11 cases, the fractures were located on the midshaft of femur and most of them was segmental or comminuted. According to AO classification, 14 cases(82%) were type B(B1:1, B2:4) and C(C1:7, C3:2). 2. The interval between initial operation and metal failure was 8 months on average. 3. The cause of metal failure were bone defect remaining after initial operation, fragment necrosis due to periosteal denuding of large free bone fragments, early weight bearing, selection of inappropriate implants and improper operation technique. 4. Plate breakages were occured in 11 cases and screw fractures and screw loosening in 6 cases. Most of plate breakage was due to remaining bone defects, and most of screw fractures and loosening was due to inappropriate implants and improper operation techinque. In conclusion, accurate preoperative evaluation on the fracture site, fracture pattern and appropriate selection of internal fixative are important for proper bone healing. Based upon our result, we suggest semiopen technique with minimal soft tissue injury and initial early bone graft for bone defect.

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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Kwang-Hee Park, Yoon-Ho Choi
Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef

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The Problem of Screw Failure at the Interlocking Nailing using AO Unlearned Tibial Nail(UTN) in the Treatment of the Tibial Shaft Fractures: Ki Young Byun, Kwang Jin Rhee, Jun Kye Lee, Deuk Soo Hwang, Chan Hee Park, Hyeong Seong Kim; J Korean Soc Fract 1996;9(2):480-488. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.480

Abstract PDF: Recently, the interlocking intramedullary nailing is being regarded as one of the best method using static or dynamic UTN(Unlearned Tibial Nail) in the treatment of the tibial shaft fractures. However it has made the locking screw break because the early weight bearing and exercise for the early bony union and the delayed removal of the static locked screw. Failure of the locking screw has not resulted in loss of reduction, but broken screw can make nail removal difficult. The authors have clinically analysed 17 patients of open tibial shaft fractures treated with static or dynamic interlocking intramedullary nailing using UTN followed by more than 6 months at Chung Nam National University Hospital from January 1993. to February 1995. 1. In all 17 cases, nails were inserted via closed method and early weight bearing was encouraged. 2. Among 17 cases, 4 cases of proximal static screw were broken, and all screw failures were occurred in static hole of proximal portion of AO UTN. 3. Among 17 cases, secondary dynamization was tried at POD 4 wks for early bony union in only one case and that revealed good result. So, We recommand that the locking screw of the proximal lowest hole should be removed before weight bearing because of its mechanical weakness, and that the start of weight bearing should be considered according to AO Groups principles including the character of the patient and fractures.

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Metal Failure in Treatment of Fracture of Femoral Shaft: S R Park, H S Kim, K H Moon, J S Kang, W H Lee, S R Shin; J Korean Soc Fract 1996;9(1):97-104. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.97

Abstract PDF: Treatments of choice for femoral shaft fracture in adult patients are plate and screws, and intramedullary nailing. Through this active treatment, early motion exercise and early weight bearing can be obtained. However, the frequency of metal failure has increased also and has become a problem in treatment of the fracture. The authors clinically analysed the metal failure in 13 cases after fixation of femoral shaft fracture, during last 7 years since from February 1988 to January 1995. We obtained the following results; 1. The interval between initial operation and metal failure was 6.8 months on average, ranging from 2 to 13 months, and the most common site of the metal failure was previous fracture site. 2. The most common cause of metal failure was dificiency of medial buttress(8 cases, 61.5%) and the most common method of the treatment was intramedullary fixation with interlocking nail and bone graft. 3. To avoid metal failure, accurate reduction of fracture, adequate immobilization and adequate postoperative management was necessary.

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Failure after Operative Fixation of Fracture in Rigid Cerebral Palsy: Report of 2 Cases: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Yong Min Kim, Hyung Ho Oh, Dong Ju Chae, Seung Hoon Lee; J Korean Soc Fract 1996;9(1):229-234. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.229

Abstract PDF: In the management of fractures in patients with cererbral palsy, pre-existing contracture of joint and muscles, difficulty in maintenance of reduction partly because of involuntary motion of muscles are obstacles to the orthopaedic surgeons. Furthermore, disuse osteopenia in long term bed-ridden patients may be a Predisposing factor of refracture. Failures such as refracture were reported to occur 19 times more in cerebral palsy patients. Those failures usually result in malunion, which may be a cause of severely deformed extremities. Among various types of cerebral palsy, rigid type is rare and involuntary muscle contraction is rigid. Therefore, fractures in these patients may be more difficult to manage and be accompanied by more complications, such as refracture compared even to spastic type. We experienced fractures in two patients with rigid cerebral palsy. An 11 year-old boy(proximal femoral shaft fracture) and a 45 year-old man(humerus shaft fracture) were treated with open reduction and internal fixation using plate and screws. Initial fixation was thought to be enoughly stable, but within 3 weeks postoperatively, maintenance of reduction in both fractures failed eventually. Because of the rarity of cases and difficulty in maintenance of reduction, we report these two cases after reviewing of the literatures.

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Clinical analysis of fixation failure in the treatment of intertro chanteric fracture of the femur: Jong Deuk Rha, Young Hoon Kim, Sung Il Yoon, Jun Soon Kang, Duck Hyun Park; J Korean Soc Fract 1991;4(2):298-305. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.298

Abstract PDF: No abstract available.

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Operative Treatment on Fracture of Distal Third of Femoral Shaft: Ki Hong Choi, Chung Nam Kang, Jin Man Wang, Kwon Jae Roh, Kang Deuk Koh; J Korean Soc Fract 1990;3(1):53-61. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.53

Abstract PDF: The fracture of distal third of femoral shaft difficult to choose method of treatment and timing of wt. bearing because of increrment of communited fracture, anatomic characteristics and complication such as metal faulure, shortening and angulation. After analysis of 52 cases of fracture of distal third femoral shaft treated operatively in the Department of Orthopaedic Surgery, Ewha Womans University Hospital during 5.5yrs from. Jan. 1984 to June 1989 except pathologic fracture, the following results were obtained. 1. By Reis and Hirschberg classification, type I, II and III fracture wore seen in 16 patients (31%), 12 patients(23%) and 24 patients(46%) respectively. 2. The rate of complication was 29%(15 cases) with 46%(7 cases) of the complication related to the nature of the implant. 3. Among the 7 cases of metal faulure, four cases was caused by early wt. bearing and uncarefulness of patients in type III fracture.

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