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110 "Intertrochanteric fracture"
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Original Article
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
J Korean Fract Soc 2022;35(4):162-168.   Published online October 31, 2022
DOI: https://doi.org/10.12671/jkfs.2022.35.4.162
AbstractAbstract PDF
Purpose
Trochanteric fixation nail advanced (TFNA) was modified to compensate for the shortcomings of proximal femoral nail antirotation-II (PFNA-II). The clinical and radiological outcomes of surgeries us-ing the PFNA-II and TFNA for femoral intertrochanteric fractures were compared.
Materials and Methods
Eighty-two patients who underwent surgeries using PFNA-II or TFNA were analyzed. Only those who were followed up for more than a year were enrolled. Bone union, shortening of the femoral neck, and the tip–apex distance of the intramedullary nail were compared in the radiological findings. Clinical outcomes, including the frequency of complications and gait ability (Koval score), were also assessed.
Results
The mean follow-up periods were 22 and 19 months for the PFNA-II and TFNA groups, re-spectively. In the PFNA-II group, two cases of femoral head cut-out and one case of varus collapse were observed. In the TFNA group, only one case of femoral head cut-out was observed; however, there was no significant difference in the frequency of complications between the two groups (p=0.37). Ad-ditionally, both the shortening of the femoral neck and the decrease in gait ability after surgery showed relative improvement in the TFNA group compared to the PFNA-II group; however, there was no sig-nificant difference between the two groups.
Conclusion
The use of both TFNA and PFNA-II was associated with satisfactory outcomes. In patients who underwent surgeries using TFNA, the recovery of gait ability, frequency of complications, and short-ening of the femoral neck were not significantly different from PFNA-II, suggesting that both are suitable instrument choices for intertrochanteric fracture treatment. However, the clinical significance must be further assessed using a larger group of patients over a longer follow-up period in future studies.

Citations

Citations to this article as recorded by  
  • 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
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Technical Note
Operative Positioning Technique for an Intertrochanteric Fracture in a Patient with an Ipsilateral Above-the-Knee Amputation - Technical Note -
Dae-Hyun Park, Yong-Uk Kwon, Dong-Seok Kim
J Korean Fract Soc 2021;34(4):137-141.   Published online October 31, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.4.137
AbstractAbstract PDF
A 45-year-old man with a remote history of a left above-the-knee amputation presented to the emergency department with left hip pain after a mechanical fall. This case was an operative challenge because commonly used intraoperative traction methods could not be applied to a patient with an above-the-knee amputation. We describe a rarely utilized surgical technique of applying traction to an amputated extremity via a Steinmann pin during closed reduction and internal fixation of an intertrochanteric fracture.

Citations

Citations to this article as recorded by  
  • Periprosthetic Femur Fractures in Osseointegration Amputees
    Jason Shih Hoellwarth, S. Robert Rozbruch
    JBJS Case Connector.2022;[Epub]     CrossRef
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Case Report
Helical Blade Locking Sleeve Disassembly Following Failed Femur Intertrochanter Fracture
Soon Ho Huh, Hong-Man Cho, Ji-Yeon Park
J Korean Fract Soc 2021;34(3):112-116.   Published online July 31, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.3.112
AbstractAbstract PDF
A helical blade type of hip screw is used widely for the operative management of femoral trochanteric fractures. A 73-year-old female patient was admitted for femoral trochanteric fracture AO/OTA type 31A2.2. A helical blade locking sleeve dissembled 18 weeks after surgery did not achieve accurate reduction. The patient underwent bipolar hip hemiarthroplasty because the fracture reduction was lost, and it was impossible to remove the remaining helical blade without bone loss. The authors report this case of a rare complication of helical blade.
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Original Articles
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
J Korean Fract Soc 2021;34(3):105-111.   Published online July 31, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.3.105
AbstractAbstract PDF
Purpose
This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation NailAdvanced; Depuy Synthes) for the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated.
Results
Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases.
Conclusion
TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.

Citations

Citations to this article as recorded by  
  • 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
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Comparison of Reductions of Left and Right Proximal Portions of Intertrochanteric Fractures Treated by Intramedullary Nailing
Hyun Cheol Oh, Joong Won Ha, Yung Park, Sang Hoon Park, Han Kook Yoon
J Korean Fract Soc 2021;34(2):64-70.   Published online April 30, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.2.64
AbstractAbstract PDF
Purpose
This study examined the effect of lag screw insertion on proximal fragments by separating the right and left sides of intertrochanteric fractures in elderly patients that underwent intramedullary nailing.
Materials and Methods
Patients aged ≥65 years that underwent intramedullary nailing after a diag-nosis of intertrochanteric fractures during the period February 2012 to May 2016 were included in the study. The subjects were divided into right and left side groups. The effect of the clockwise rotational force generated when a lag screw was inserted on the proximal fragment was evaluated in both groups.
Results
In the right and left groups, most proximal fragments were located in the intramedullary canal after surgery (45 cases [75.0%] and 67 cases [73.6%], respectively). Clockwise rotation due to lag screw placement in the right group occurred in two cases (3.3%), which both showed internal rotation, and in four cases (4.4%) in the left group, all of which showed external rotation.
Conclusion
After intramedullary nailing of intertrochanteric fractures in elderly patients, proximal fragments were mostly located in the intramedullary cavity. The results obtained confirmed that the clockwise rotational force generated by lag screw insertion did not affect left or right sides.

Citations

Citations to this article as recorded by  
  • Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results
    You-Sung Suh, Jae-Hwi Nho, Min Gon Song, Dong Woo Lee, Byung-Woong Jang
    Clinics in Orthopedic Surgery.2023; 15(3): 373.     CrossRef
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Comparison of the U-Blade Gamma3 Nail and the Zimmer Natural Nail for the Treatment of Intertrochanteric Fracture
Jae Sung Suh, Hyung-Gon Ryu, Young Ju Roh, Dae Won Shin, Sang-Min Kim
J Korean Fract Soc 2021;34(2):57-63.   Published online April 30, 2021
DOI: https://doi.org/10.12671/jkfs.2021.34.2.57
AbstractAbstract PDF
Purpose
This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN).
Materials and Methods
The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared.
Results
Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted.
Conclusion
No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.
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Clinical and Radiological Outcomes of Polished Cemented Bipolar Hemiarthroplasty for Intertrochanteric Fractures in Elderly Patients
Suc-Hyun Kweon, Chang-Hyun Shin, Yeong-Chang Lee, Min-Woo Kim, Tae-Ho Kim
J Korean Fract Soc 2020;33(3):134-141.   Published online July 31, 2020
DOI: https://doi.org/10.12671/jkfs.2020.33.3.134
AbstractAbstract PDF
Purpose
To evaluate the clinical and radiological outcomes of bipolar hemiarthroplasty using a polished cemented femoral stem for intertrochanteric fractures in elderly patients.
Materials and Methods
From July 2005 to May 2015, 48 patients diagnosed with intertrochanteric fractures underwent bipolar hemiarthroplasty. The mean age and follow-up period were 80.5 years and 30.5 months, respectively. The postoperative results were evaluated clinically and radiologically.
Results
The mean operation time was 100 minutes (range, 90-120 minutes), and the mean amount of blood loss was 334 ml (range, 170-500 ml). At the last follow-up, the mean Harris hip score (HHS), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 82.2 (range, 76-90), 0.8 (range, 1-3), and 36 (range, 30-40), respectively. Walking was initiated using a walker for partial weight-bearing, and the mean walking time was 5.8 days (range, 3-14 days). Ambulatory ability was restored to a walking state before the injury in 36 cases (75.0%), and wheelchair ambulation was possible in 12 cases (25.0%). The instrumental activities of daily living (IADLs) were 17 patients (35.4%), and the basic activities of daily living (BADLs) were 31 patients (64.6%).
Conclusion
Polished cemented bipolar hemiarthroplasty can achieve secure fixation with no postoperative thigh pain. Restoring the preoperative walking ability will be more helpful for intertrochanteric fractures in elderly patients.
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The Effects of Extramedullary Reduction in Unstable Intertrochanteric Fracture: A Biomechanical Study Using Cadaver Bone
Young Chang Park, Soon Phil Yoon, Kyu Hyun Yang
J Korean Fract Soc 2018;31(3):79-86.   Published online July 31, 2018
DOI: https://doi.org/10.12671/jkfs.2018.31.3.79
AbstractAbstract PDF
PURPOSE
To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2).
MATERIALS AND METHODS
Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified.
RESULTS
The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens.
CONCLUSION
In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.

Citations

Citations to this article as recorded by  
  • The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures: A multicenter randomized controlled trial
    Takashi Maehara, Takashi Hayakawa, Shunsuke Mukoyama, Yoshihisa Anraku, Takahiro Hamada, Hiroyuki Suzuki, Takeshi Doi, Tomohiko Shimizu, Masanori Yorimitsu, Hidefumi Teramoto, Takao Mae, Yasunori Okamoto, Jun Hara, Kazushi Mihara, Koichi Kanekasu
    Injury.2024; 55(10): 111725.     CrossRef
  • Anteromedial cortical support reduction of intertrochanteric fractures–A review
    Wenjun Xie, Liu Shi, Cheng Zhang, Xueliang Cui, Xiangxu Chen, Tian Xie, Sheng Zhang, Hui Chen, Yunfeng Rui
    Injury.2024; 55(12): 111926.     CrossRef
  • Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures
    Wei Mao, Chen-Dong Liu, Shi-Min Chang, Ao-Lei Yang, Choon Chiet Hong
    Journal of Bone and Joint Surgery.2024; 106(11): 1008.     CrossRef
  • Five states of reduction in OTA/AO A1.3 intertrochanteric fractures of the femur a biomechanical study
    Shu Li, Yong-Gang Bao, Rong-Hua Tian, Chun-Yang Meng, Hai-Bin Wang, Bin Wu, Xian-Min Bu
    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
  • Intramedullary Impaction of the Basicervical Component is Determinant of Fixation Failure in a Simple Two-Part Pertrochanteric Fracture
    Seok Ha Hong, Kang Hun Yu, Seung Beom Han
    Journal of Orthopaedic Trauma.2024;[Epub]     CrossRef
  • Flexible reamer use to overcome entry point errors in proximal femoral nail application in severe obese intertrochanteric fracture patients
    Levent Horoz, Ali Ihsan Kilic, Cihan Kircil, Mehmet Fevzi Cakmak
    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
  • Risk Factors Associated with Fixation Failure in Intertrochanteric Fracture Treated with Cephalomedullary Nail
    Hyung-Gon Ryu, Dae Won Shin, Beom Su Han, Sang-Min Kim
    Hip & Pelvis.2023; 35(3): 193.     CrossRef
  • Positive or negative anteromedial cortical support of unstable pertrochanteric femoral fractures: A finite element analysis study
    Qin Shao, Yue Zhang, Gui-Xin Sun, Chen-Song Yang, Na Liu, Da-Wei Chen, Biao Cheng
    Biomedicine & Pharmacotherapy.2021; 138: 111473.     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
  • Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation
    Oog-Jin Shon, Chang Hyun Choi, Chan Ho Park
    Hip & Pelvis.2021; 33(3): 154.     CrossRef
  • Additional Reduction Screw Fixation Technique for Pertrochanteric Hip Fractures: A Novel Method to Prevent Excessive Sliding in Cephalomedullary Nail Surgery
    Chul-Ho Kim, Han Soul Kim, Dou Hyun Moon
    Hip & Pelvis.2021; 33(3): 162.     CrossRef
  • Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: A systematic review and meta-analysis
    Eic Ju Lim, Seungyeob Sakong, Whee Sung Son, Jae-Woo Cho, Jong-Keon Oh, Chul-Ho Kim
    Injury.2021; 52(10): 2787.     CrossRef
  • A new fluoroscopic view for evaluation of anteromedial cortex reduction quality during cephalomedullary nailing for intertrochanteric femur fractures: the 30° oblique tangential projection
    Shi-Yi Chen, Shi-Min Chang, Rujan Tuladhar, Zhen Wei, Wen-Feng Xiong, Sun-Jun Hu, Shou-Chao Du
    BMC Musculoskeletal Disorders.2020;[Epub]     CrossRef
  • New Approach in the Treatment of Intertrochanteric Fracture Using a Cephalomedullary Nail
    Junyoung Kim, Kihong Choi, Kyu Hyun Yang
    Journal of the Korean Orthopaedic Association.2020; 55(3): 193.     CrossRef
  • Effect of a synthetic osteoconductive bone graft substitute with zeta potential control (geneX®ds) in the treatment of intertrochanteric fracture: A single center experience of 115 consecutive proximal femoral nail antirotations
    Won Chul Shin, Jae Hoon Jang, Jae Yoon Jeong, Kuen Tak Suh, Nam Hoon Moon
    Journal of Orthopaedic Science.2019; 24(5): 842.     CrossRef
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Case Report
Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing: A Case Report
Jung Woo Lee, Hong Man Cho, Jae Woong Seo
J Korean Fract Soc 2017;30(4):203-208.   Published online October 31, 2017
DOI: https://doi.org/10.12671/jkfs.2017.30.4.203
AbstractAbstract PDF
Hip fractures are common among elderly individuals. Internal fixation with the intramedullary system has been widely used to treat intertrochanteric femur fractures. The Gamma 3 nail is a useful device for fixating trochanteric fractures of the proximal femur. We report a rare complication of medial pelvic penetration of the lag screw of a Gamma 3 nail two months after surgery. There was a complete separation between the nail body and lag screw, and the lag screw penetrated through the acetabulum into the pelvis. We report a case of unstable intertrochanteric fracture with intrapelvic penetration after surgical treatment with proximal femoral nailing and a case followed by fatal results.

Citations

Citations to this article as recorded by  
  • Endovascular assisted removal of intrapelvic lag screw after intramedullary proximal femoral nail: A case report and literature review
    Zakaria Mousati, Mathias Van Den Broek, Joren Callaert, Jan Gielis, Kris Govaers
    Trauma Case Reports.2023; 46: 100873.     CrossRef
  • Intrapelvic migration of the lag screw in intramedullary nailing after intertrochanteric fracture fixation: A case report
    Aymen Ben Fredj, Hedi Rbai, Fourat Farhat, Marouen Berriri
    Clinical Case Reports.2022;[Epub]     CrossRef
  • Intramedullary nailing confers an increased risk of medial migration compared to dynamic hip screw fixation in unstable intertrochanteric hip fractures
    Gin Way LAW, Yoke Rung WONG, Antony GARDNER, Yau Hong NG
    Injury.2021; 52(11): 3440.     CrossRef
  • Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures
    G. W. Law, Y. R. Wong, A. K-S. Yew, A. C. T. Choh, J. S. B. Koh, T. S. Howe
    Bone & Joint Research.2019; 8(7): 313.     CrossRef
  • Intrapelvic Migration of the Lag Screw with Wedge Wing from Dyna Locking Trochanteric Nail: A Case Report and Literature Review
    Yong-Woo Kim, Weon-Yoo Kim, Kyong-Jun Kim, Se-Won Lee
    Hip & Pelvis.2019; 31(2): 110.     CrossRef
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Original Articles
Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients
Kyung Hoon Lee, Suk Ku Han, Seung Jae Chung, Jongho Noh, Kee Haeng Lee
J Korean Fract Soc 2016;29(3):192-199.   Published online July 31, 2016
DOI: https://doi.org/10.12671/jkfs.2016.29.3.192
AbstractAbstract PDF
PURPOSE
The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate.
MATERIALS AND METHODS
From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done.
RESULTS
The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications.
CONCLUSION
Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.
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A Comparative Study of TRIGENâ„¢ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures
Jae Hoon Jang, Jeung Il Kim, Um Ji Kim, Nam Hoon Moon
J Korean Fract Soc 2016;29(2):128-136.   Published online April 30, 2016
DOI: https://doi.org/10.12671/jkfs.2016.29.2.128
AbstractAbstract PDF
PURPOSE
The primary purpose of this study was to demonstrate that the TRIGENâ„¢ INTERTAN nail (InterTAN) could show better clinical outcome compared to the proximal femoral nail antirotation 2 (PFNA2) for treatment of intertrochanteric fracture in the elderly.
MATERIALS AND METHODS
Between March 2009 and December 2013, 164 patients with intertrochanteric fractures who met our inclusion and exclusion criteria were enrolled in this study. Evaluation variables, including operation time, blood loss during the operation, incidence of perioperative complications, clinical results at the last follow-up, and radiographic findings were assessed for comparison of the 2 implants.
RESULTS
Intraoperative lateral wall fracture was significantly higher in the PFNA2 group (p<0.05) and tip apex distance was significantly higher in the InterTAN group (p<0.05). Sliding of the proximal fragment at the last follow-up was significantly higher in the PFNA2 group. However, there was no significant difference in union rate, time to union, postoperative complications, and clinical outcomes at the last follow-up between the 2 groups.
CONCLUSION
Based on these data, clinical outcomes at the last follow-up were equivalent between InterTAN and PFNA2.

Citations

Citations to this article as recorded by  
  • Unstable Intertrochanteric Fracture: Do We Know Everything? A Review
    Balaji Zacharia, Harshitha Hayavadana Udupa
    SN Comprehensive Clinical Medicine.2022;[Epub]     CrossRef
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Perioperative Blood Loss in Intramedullary Hip Screw for Intertrochanteric Fracture: Analysis of Risk Factors
Jai Hyung Park, Hwa Jae Jung, Hun Kyu Shin, Eugene Kim, Se Jin Park, Taeg Su Ko, Jong Hyon Park
J Korean Fract Soc 2015;28(1):53-58.   Published online January 31, 2015
DOI: https://doi.org/10.12671/jkfs.2015.28.1.53
AbstractAbstract PDF
PURPOSE
We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors.
MATERIALS AND METHODS
A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents.
RESULTS
Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference.
CONCLUSION
Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.
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Results of Use of Compression Hip Screw with Trochanter Stabilizing Plate for Reverse Oblique Intertrochanteric Fracture
Byung Woo Min, Kyung Jae Lee, Gyo Wook Kim, Ki Cheor Bae, Si Wook Lee, Du Han Kim
J Korean Fract Soc 2014;27(2):120-126.   Published online April 30, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.2.120
AbstractAbstract PDF
PURPOSE
The aim of this study was to analyze the use of a compression hip screw with a trochanter stabilizing plate for treatment of reverse oblique intertrochanteric fractures.
MATERIALS AND METHODS
We reviewed the results of 33 cases of reverse oblique intertrochanteric fracture treated with a compression hip screw with a trochanter stabilizing plate from January 2000 to December 2012 which were followed-up for more than one year. We evaluated postoperative bone union period, change of neck-shaft angle, sliding of hip screw, and other complications.
RESULTS
Of 33 patients, satisfactory reduction was achieved in 28 patients. Five patients had an unsatisfactory reduction, with two cases of excessive screw sliding, one of broken metal, one of varus deformity, and one of internal rotation deformity. We performed corrective osteotomy in varus and internal rotation deformity and partial hip replacement in a case of excessive screw sliding. Bone union was achieved in 29 patients, and the average bone union period was 19.2 weeks.
CONCLUSION
We consider that a compression hip screw with a trochanteric stabilized plate is a good option for treatment of reverse oblique intertrochanteric femoral fractures. However, adequate fracture reduction and ideal implant placement are a basic necessity for successful treatment.
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Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture
Dong Hyeok Choi, Ju Yeong Heo, Young Jae Jang, Young Yool Chung
J Korean Fract Soc 2014;27(1):58-64.   Published online January 31, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.1.58
AbstractAbstract PDF
PURPOSE
We classified fractures of the greater trochanter (GT) and evaluated fracture fragment stability according to GT type.
MATERIALS AND METHODS
A total of 43 patients with an unstable intertrochanteric fracture treated between January 2007 and July 2009 with bipolar hemiarthroplasty were included in this study. GT fractures were classified as type A, B, C, or D and fixed using either cerclage wiring alone, cerclage wiring and non-absorbable suture or a greater trochanteric reattachment (GTR) plate.
RESULTS
Type A fractures were fixed using cerclage wiring with non-absorbable suture in two cases, cerclage wiring in six cases and GTR plate in seven cases. Failure occurred in three cases of type A fractures treated with cerclage wiring alone. A total of 11 type B fractures were fixed with cerclage wiring (7), cerclage wiring and non-absorbable suture (3) and GTR plate (1). There was no failure of type B fractures. Type C fractures were fixed using cerclage wiring with non-absorbable suture in one case and GTR plate in three. There was no fixation in three cases. Of 10 type D fractures, six were treated with cerclage wiring and one with GTR plate. Fixation was not performed in three patients. There was no failure in type C and D type fractures.
CONCLUSION
Fracture fragment stability differed according to fracture types. Cerclage wiring alone was insufficient to fix type A fractures, so type A fracture required a stronger fixation method.

Citations

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  • Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique
    Javahir A. Pachore, Vikram Indrajit Shah, Sachin Upadhyay, Shrikunj Babulal Patel
    Hip & Pelvis.2023; 35(2): 108.     CrossRef
  • The Efficacy of Suture Fixation of the Greater Trochanter in Unstable Intertrochanteric Fractures
    Ki-Choul Kim, Hee-Gon Park, Jae-Wook Park
    Clinics in Orthopedic Surgery.2021; 13(4): 468.     CrossRef
  • Is rigid fixation of the greater trochanter necessary for arthroplasty of intertrochanteric fractures?
    Kee Haeng Lee, Dong Hun Lee, Jong Ho Noh, Yoon Vin Kim
    Orthopaedics & Traumatology: Surgery & Research.2019; 105(1): 41.     CrossRef
  • Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures
    Min-Wook Kim, Young-Yool Chung, Sung-an Lim, Seung-Woo Shim
    Hip & Pelvis.2019; 31(3): 144.     CrossRef
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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
J Korean Fract Soc 2014;27(1):36-41.   Published online January 31, 2014
DOI: https://doi.org/10.12671/jkfs.2014.27.1.36
AbstractAbstract PDF
PURPOSE
To evaluate whether the radiological and clinical results of treatment with intertrochanteric/subtrochanteric (ITST) nail on unstable intertrochanteric fractures are combined with comminution of the greater trochanter or not.
MATERIALS AND METHODS
We reviewed the results on 210 cases of unstable intertrochanteric fractures (grouped 88 patients with comminution of greater trochanter [GT] and 122 patients without comminution of GT) treated with ITST nail from January 2007 to October 2011, which was to be followed-up for more than 12 months.
RESULTS
The mean union time was 15.2 weeks in the study group (combined with comminution of GT). The mean union time was 14.7 weeks in control group (no comminution of GT). The lag screw sliding was 8.7 mm in the study group and 7.2 mm in the control group. Changes of neck-shaft angle was 4.2degrees in study group and 4.1degrees in control group. Tip-apex distance was 17.4 mm in study group and 16.4 mm in control group. The complications were 4 cases in each study group and control group. The clinical results checked by Skovron recovery scores decreased similarly in both groups, 73.7% in study group and 76.5% in control group. There were no significant differences in both groups according to radiological and clinical results.
CONCLUSION
The comminution of great trochanter does not affect on the radiological and clinical results when using the ITST nail of unstable intertrochanteric fractures.
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Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures
Jee Hoon Kim, Oog Jin Shon
J Korean Fract Soc 2013;26(4):305-313.   Published online October 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.4.305
AbstractAbstract PDF
PURPOSE
To compare the results between Proximal femoral nail antirotation II (PFNA II) and Zimmer natural nail Asia type (ZNN) for the treatment of stable intertrochanteric fractures.
MATERIALS AND METHODS
Between September 2011 and September 2012, 40 consecutive patients with stable intertrochanteric femoral fractures were treated with PFNA II or ZNN. We reviewed 20 cases of PFNA II and 20 cases of ZNN prospectively. We evaluated the operation time, amount of bleeding, mean hospital day, and capability of mobility and function using 'mobility score of Parker and Palmer' and 'social score of Jensen'. We also evaluated the reduction state by the Fogagnolo, Cleveland index, change of tip and apex distance (TAD), sliding distance of cervical screw, change of neck shaft angle and bone union time.
RESULTS
There were no significant differences between the groups treated with PFNA and ZNN. Both groups showed good clinical results. PFNA showed less TAD change and ZNN showed a shorter sliding distance of cervical screw, but they were not statistically different. The bone union time was approximately 13 weeks in both groups.
CONCLUSION
PFNA and ZNN produced good clinical and radiologic results in the treatment of stable intertrochanteric fractures. There were no significant differences between the groups. Both implants provide good stability and union, so we can conclude that they are both suitable for the treatment of stable intertrochanteric fractures.

Citations

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  • 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
  • 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
  • Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail
    Woong Chae Na, Chae Won Lim, Sang Hong Lee
    Medical Biological Science and Engineering.2018; 1(2): 45.     CrossRef
  • BONE HEALING PATTERNS OF INTERLOCKED INTRAMEDULLARY NAIL-FIXATED FEMORAL SHAFT FRACTURES: AGE-MATCHED RADIOGRAPHIC PRESENTATION OF UNION PATTERN
    Myung-Sang Moon, Dong-Hyeon Kim, Bong-Keun Park, Min-Geun Yoon
    Journal of Musculoskeletal Research.2017; 20(02): 1750010.     CrossRef
  • The Curative Effect Comparison Between Prolonged Third Generation of Gamma Nail and Prolonged Dynamic Hip Screw Internal Fixation in Treating Femoral Intertrochanteric Fracture and the Effect on Infection
    Wenye He, Wei Zhang
    Cell Biochemistry and Biophysics.2015; 71(2): 695.     CrossRef
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A Comparison between Compression Hip Screw and Intramedullary Nail for the Treatment of AO/OTA A2.2 Intertrochanteric Femoral Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Jong Hyun Kim
J Korean Fract Soc 2013;26(1):44-49.   Published online January 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.1.44
AbstractAbstract PDF
PURPOSE
To compare the result between the compression hip screw (CHS) and intramedullary (IM) nail for the treatment of AO/OTA A2.2 intertrochanteric fracture.
MATERIALS AND METHODS
We retrospectively reviewed 95 cases of AO/OTA A2.2 intertrochanteric fracture, which were treated with CHS or IM nail by one surgeon from March 1994 to December 2009. One group was treated with CHS (Group I, 28 cases) and the other was treated with IM nail (Group II, 67 cases). We evaluated the mean operation time, the amount of bleeding and transfusion, hospital duration, radiological results and the clinical outcome with the mobility score of Parker and Palmer.
RESULTS
Radiologically, the tip-apex distance, change of neck-shaft angle, and union time were not significantly different between both groups (p>0.05). Clinically, the mean operation time, the amount of bleeding and transfusion, hospital duration and the mobility score were not significantly different (p>0.05). The post-operative complications were lag screw slippage over 25 mm (1 case) and loosening of device (1 case) in group I. In group II, there were perforation of the femoral head (1 case), nail breakage (1 case) and deep infection (1 case).
CONCLUSION
There was no significant differences that are clinical and radiological results in the treatment of AO/OTA A2.2 intertrochanteric fracture, using CHS and IM nail.

Citations

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  • A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures
    Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, In Hwa Back, Kyeong Soo Eom
    Journal of the Korean Orthopaedic Association.2016; 51(6): 493.     CrossRef
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Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
Jae Cheon Sim, Tae Ho Kim, Ki Do Hong, Sung Sik Ha, Jong Seong Lee
J Korean Fract Soc 2013;26(1):37-43.   Published online January 31, 2013
DOI: https://doi.org/10.12671/jkfs.2013.26.1.37
AbstractAbstract PDF
PURPOSE
To compare the result between the third generation gamma nail (gamma 3 nail) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric fractures.
MATERIALS AND METHODS
Between March 2009 and June 2011, 47 consecutive patients with unstable intertrochanteric femoral fractures were treated with gamma 3 nail or PFNA. We reviewed 24 cases of gamma 3 nail and 23 cases of PFNA. Retrospectively, we evaluated the mean operation time, amount of bleeding, average union period, reduction status, change of neck shaft angle, Tip-apex distance, Cleveland index, sliding of lag screw and complication on set of telephone interview and outpatient. We also evaluated the postoperative capability of function and mobility, using 'Modified Koval index'.
RESULTS
There were no significant differences between the groups, which were treated with gamma 3 nail and PFNA. In addition, they did not show statistical difference. We experienced 2 cases of complication (gamma 3 nail 1 case, PFNA 1 case), which were cut-out of the femoral head.
CONCLUSION
The gamma 3 nail and PFNA were seen with good results in the treatment of unstable intertrochanteric fracture.

Citations

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  • Comparative analysis of operation time and intraoperative fluoroscopy time in intramedullary and extramedullary fixation of trochanteric fractures
    Milan Mitkovic, Sasa Milenkovic, Ivan Micic, Predrag Stojiljkovic, Igor Kostic, Milorad Mitkovic
    Vojnosanitetski pregled.2022; 79(2): 177.     CrossRef
  • Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis
    Chul-Ho Kim, Han Soul Kim, Yong-Chan Kim, Dou Hyun Moon
    Journal of Orthopaedic Trauma.2021; 35(8): 401.     CrossRef
  • The Curative Effect Comparison Between Prolonged Third Generation of Gamma Nail and Prolonged Dynamic Hip Screw Internal Fixation in Treating Femoral Intertrochanteric Fracture and the Effect on Infection
    Wenye He, Wei Zhang
    Cell Biochemistry and Biophysics.2015; 71(2): 695.     CrossRef
  • Accuracy of the Lesser Trochanter for Guiding Lag Screw Insertion in Hip Fracture Management
    Jianlin Xiao, Zhongli Gao, Yanguo Qin, Xuezhou Li, Ao Wang, Lanyu Zhu, Jincheng Wang
    Orthopedics.2014;[Epub]     CrossRef
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The Treatment of Intertrochanteric Femoral Fracture with Proximal Femoral Nail Antirotation
Jong Won Kim, Hyun Soo Park, Young Soo Jang, Jae Hyuk Choi, Sung Ju Bae, Chan Il Bae
J Korean Fract Soc 2012;25(4):257-262.   Published online October 31, 2012
DOI: https://doi.org/10.12671/jkfs.2012.25.4.257
AbstractAbstract PDF
PURPOSE
This study was performed to evaluate the results of treating intertrochanteric fracture with proximal femoral nail antirotation (PFNA).
MATERIALS AND METHODS
We performed PFNA on 41 intertrochanteric femur fracture patients from May 2008, to August 2010. We analyzed the operation time, blood loss, recovery of ambulatory function, T-score, the tip apex distance (TAD), the sliding distance of the blade, neck-shaft angle, and complications.
RESULTS
The mean operation time was 51 minutes and the mean amount of blood loss was 350 ml. The time to ambulation averaged 7.2 days. Thirty-two cases (79%) recovered their previous walking status at 6 months after operation. The average T-score was 3.3 and TAD was 12.3 mm (8.6~27 mm). 35 cases (87%) achieved acceptable reduction. The average amount of PFNA blade sliding was 3.3 mm. The neck-shaft angle was changed 2.6 degrees varus displacement at the final follow-up. There was one case of nonunion due to tuberculosis infection.
CONCLUSION
The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of intertrochanteric fracture of the femur.
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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
AbstractAbstract 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.

Citations

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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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Case Report
Simultaneous Bilateral Proximal Femoral Fracture associated with Generalized Tonic-Clonic Seizure: A Case Report
Sang Hoo Lee, Kyeong Seop Song, Seung Joo Jeon, Seong Hwan Hong
J Korean Fract Soc 2012;25(1):69-72.   Published online January 31, 2012
DOI: https://doi.org/10.12671/jkfs.2012.25.1.69
AbstractAbstract PDF
Simultaneous bilateral proximal femoral fractures are extremely rare, and a few have been reported in and outside the country. It may have various causes, and most cases were associated with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, and anti-epileptic medications. We experienced a case of simultaneous bilateral proximal femoral fractures after generalized tonic-clonic seizure in a 70-year-old female. Herein, we report it with a review of the literature.
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Original Articles
Surgical Treatment of Femoral Unstable Intertrochanteric Fractures in Elderly Patients: Comparative Study between Compressive Hip Screws and Additional Trochanteric Stabilizing Plates
Kap Jung Kim, Dae Suk Yang, Sang Ki Lee, Won Sik Choy, Kyoung Wan Bae
J Korean Fract Soc 2011;24(4):295-300.   Published online October 31, 2011
DOI: https://doi.org/10.12671/jkfs.2011.24.4.295
AbstractAbstract PDF
PURPOSE
To evaluate the radiologic results between compressive hip screw and compressive hip screw with additional trochanteric stabilizing plate in patients with femoral unstable intertrochanteric fractures in patients with more 65 years old.
MATERIALS AND METHODS
From 2006 to May 2009, 121 cases were included. Group I (compressive hip screw only) was 54 cases and group II (compressive hip screw with trochanteric stabilizing plate) was 67 cases. We checked the lag screw sliding, lateral translation of greater trochanter, changes of neck-shaft angle and complications through periodic follow up of radiographs.
RESULTS
Mean lag screw sliding was 7.6 mm in group I and 3.9 mm in group II (p=0.001). Mean lateral translation of greater trochanter was 3.86 mm in group I and 0.59 mm in group II (p=0.01). Mean changes of neck-shaft angle was nearly the same, 3.57degrees in group I and 3.66degrees in group II. Complications were 15 cases in group I and 10 cases in group II.
CONCLUSION
Compressive hip screw with additional trochanteric stabilizing plate was effective surgical option in patients with femoral unstable intertrochanteric fractures in patients with more than 65 years old. It decreased lag screw sliding, lateral translation of greater trochanter and complication rates.

Citations

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  • The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture
    Chul-Ho Kim, Ji Wan Kim, Eic Ju Lim, Jae Suk Chang
    Journal of the Korean Fracture Society.2016; 29(4): 250.     CrossRef
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The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table
Jeoung Ho Kim, Sang Hong Lee, Kwang Chul Lee, Sung Won Cho
J Korean Fract Soc 2011;24(3):217-222.   Published online July 31, 2011
DOI: https://doi.org/10.12671/jkfs.2011.24.3.217
AbstractAbstract PDF
PURPOSE
The purpose of this study is to analyze the results of intertrochanteric fractures treatment with proximal femoral nail antirotation (PFNA) without using fracture tables and thereby prevent complications.
MATERIALS AND METHODS
Forty cases of intertrochanteric fracture of 39 patients that were treated with PFNA without using fracture tables between January 2008 to December 2009 were analyzed. There were 13 males and 27 females. The mean age was 76 years old. Using AO classification, 6 cases were A1, 25 cases were A2 and 9 cases were A3. The operation was done without using fracture tables at supine position. Operation time, intraoperative bleeding were checked. For the result, Cleveland index, tip apex distance, fracture site sliding rate, change of femur neck and shaft angle were evaluated. Bone union time and complications were also estimated from the follow up radiograph. Statistics were analyzed using Independent T-test.
RESULTS
The mean operation time was 40 minutes (25 to 70 minutes) and mean intraoperative bleeding was 113 cc (40 to 250 cc). The Cleveland index was shown 94% of 5, 6, 8 and 9 zone, the tip apex distance was 12.96 mm (6 to 22 mm), the fracture sliding distance was 1.9 mm (0 to 6 mm), the change of femur neck and shaft angle was 2.5 degree (0~10 degree) and the average bone union time was 15 weeks (8 to 24 weeks). The complication include 2 cases of delayed union and 2 cases of varus deformities.
CONCLUSION
We have shortened the operation time by closed reduction methods without using the fracture tables, and the complication were minimized with using simple tools like a reduction forcep or bone hook at PFNA blade insertion.

Citations

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  • 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
  • The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation
    Chi Hyoung Pak, Sang Hong Lee, Sang Ho Ha, Gwang Chul Lee, Kyoung Chul Song
    Journal of the Korean Fracture Society.2013; 26(4): 284.     CrossRef
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Delirium after Intertrochanteric Fractures of Femur in Elderly Patients
Kyu Bok Kang, Dong Hun Suh, Seong Rok Oh
J Korean Fract Soc 2011;24(2):131-137.   Published online April 30, 2011
DOI: https://doi.org/10.12671/jkfs.2011.24.2.131
AbstractAbstract PDF
PURPOSE
To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur.
MATERIALS AND METHODS
162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors.
RESULTS
2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium.
CONCLUSION
Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.

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  • Incidence and Associated Factors of Delirium after Orthopedic Surgery
    Si-Wook Lee, Chul-Hyun Cho, Ki-Cheor Bae, Kyung-Jae Lee, Eun-Seok Son, Sang-Hyun Um
    Journal of the Korean Orthopaedic Association.2019; 54(2): 157.     CrossRef
  • Laozi. De la figure du maître mythique à la divinité taoïque
    Kyong-Kon Kim
    Archimède. Archéologie et histoire ancienne.2019; 6: 16.     CrossRef
  • Outcomes of Patients With Delirium in Long-Term Care Facilities: A Prospective Cohort Study
    Kyoung Ja Moon, Heeok Park
    Journal of Gerontological Nursing.2018; 44(9): 41.     CrossRef
  • Relationship between Delirium and Clinical Prognosis among Older Patients underwent Femur Fracture Surgery
    Jae-Lan Shim, Seon-Young Hwang
    Journal of the Korea Academia-Industrial cooperation Society.2016; 17(2): 649.     CrossRef
  • The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial
    Kyoung-Ja Moon, Sun-Mi Lee
    International Journal of Nursing Studies.2015; 52(9): 1423.     CrossRef
  • Automatic Delirium Prediction System and Nursing-Sensitive Outcomes in the Medical Intensive Care Unit
    Ha-young Cho, Xianghua Song, Jinshi Piao, Yinji Jin, Sun-Mi Lee
    Clinical Nursing Research.2015; 24(1): 29.     CrossRef
  • Postoperative Delirium in Elderly Patients with Osteoarthritis Surgery: Incidence and Risk Factors
    Eun A Park, Min Young Kim
    Journal of muscle and joint health.2015; 22(2): 57.     CrossRef
  • Is Delirium an Unrecognized Threat to Patient Safety in Korean Intensive Care Units?
    Kyoung-Ja Moon, Jinshi Piao, Yinji Jin, Sun-Mi Lee
    Journal of Nursing Care Quality.2014; 29(1): 91.     CrossRef
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Case Report
Lateral Positioning for Proximal Femoral Nailing of the Intertrochanteric Fracture: Surgical Technique
Kwan Hee Lee, Hoon Jeong, Jong Kyoung Ha, Yong Ju Kim, Won Hee Jang
J Korean Fract Soc 2011;24(1):79-82.   Published online January 31, 2011
DOI: https://doi.org/10.12671/jkfs.2011.24.1.79
AbstractAbstract PDF
In the treatment of intertrochanteric fractures, most of intramedullary nailings are performed on a fracture table in supine position. In supine position, however, soft tissue mass of the patients and drapes make it difficult to access to the piriformis fossa and to straighten the trajectory of reamer and nail insertion. To resolve these problems, we have treated twenty intertrochanteric fractures in lateral position on the general operation table with IM nail. Adjustment of the position of lag screw in femoral head was done with the technique that overlaps the shadows of the femoral head, nail and targeting guide in the lateral view. Because the entire injured limb can be moved readily, it was easy to reduce fracture and to convert to open procedure. In cases likely that the fracture table is unavailable in which patients are obese, have short stature or are amputated, and that open procedure is strongly likelihood, lateral position will be helpful technique in the treatment of intertrochanteric fractures with IM nail.

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  • Outcomes of Internal Fixation with Compression Hip Screws in Lateral Decubitus Position for Treatment of Femoral Intertrochanteric Fractures
    Cheon-Gon Park, Taek-Rim Yoon, Kyung-Soon Park
    Hip & Pelvis.2018; 30(4): 254.     CrossRef
  • The Effects of Sa-Am Spleen-tonifying Acupuncture on Radial Pulse in Healthy Human Subjects
    Kwang Sik Yoon, Hyun Lee
    The Acupuncture.2013; 30(4): 1.     CrossRef
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Original Articles
Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture
Ki Do Hong, Jae Chun Sim, Sung Sik Ha, Tae Ho Kim, Yoon Ho Choi, Jong Hyun Kim
J Korean Fract Soc 2011;24(1):7-15.   Published online January 31, 2011
DOI: https://doi.org/10.12671/jkfs.2011.24.1.7
AbstractAbstract PDF
PURPOSE
To evaluate clinical and radiological results of surgical treatment of femur intertrochantenric fracture using Gamma 3 nail.
MATERIALS AND METHODS
With clinical study, 22 patients who were treated surgically by Gamma 3 nail were retrospectively evaluated. By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Neck-shaft angle change Lag screw slippage and Union time. And By medical record review, the clinical results were evaluated with the operation time, intraperative estimated blood loss, amount of transfusion, change of mobility and complication.
RESULTS
The mean change of femur neck shaft angle was 5.18 degrees. The mean lag screw sliding was 5.43 mm. The mean bone union time was 11.8 weeks. From all of these examples shows bone union. The mean operative time was 41 min, blood loss was 161 ml and the transfusion amount was 0.3 pint. In Ceder et al mobility score, it showed 0.2 point decreased and in Jensen social function score, it showed 0.6 point increased. Comparing the results before and after operation, the results were satisfactory.
CONCLUSION
Using the Gamma 3 nail, the treatment of fermur intertrochanteric fractures showed good results both radiologically and clinically.

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  • Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS)
    Kyu Yeol Lee, Sung Soo Kim, Hyeon Jun Kim, Dong Ho Ha, Hyung Min Yoon, Hyun Su Do
    Hip & Pelvis.2015; 27(1): 36.     CrossRef
  • Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures
    Bing Zhe Huang, Yong Wook Park, Jin Su Park, Kyu Cheol Noh, Soung Yon Kim, Kook Jin Chung, Hong Kyun Kim, Hyong Nyun Kim, Yong Hyun Yoon, Ji Hyo Hwang
    Journal of the Korean Fracture Society.2014; 27(3): 213.     CrossRef
  • Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail
    Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Dae Jung Huh
    Hip & Pelvis.2013; 25(1): 51.     CrossRef
  • Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
    Jae-Cheon Sim, Tae-Ho Kim, Ki-Do Hong, Sung-Sik Ha, Jong-Seong Lee
    Journal of the Korean Fracture Society.2013; 26(1): 37.     CrossRef
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The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail
Jong Oh Kim, Young One Ko, Mi Hyun Song
J Korean Fract Soc 2011;24(1):1-6.   Published online January 31, 2011
DOI: https://doi.org/10.12671/jkfs.2011.24.1.1
AbstractAbstract PDF
PURPOSE
To evaluate the efficiency of additional fixation of the alternative bone substitute in unstable intertrochanteric fractures treated with gamma nail and alternative bone substitute and only with gamma nail.
MATERIALS AND METHODS
Radiologic comparison was done between forty-four patients of unstable intertrochanteric fracture (AO type A2.2, A2.3) during six months. The patients were divided into two groups, a group treated with gamma nail and alternative bone substitute (22 patients, group 1) and another group treated only with gamma nail (22 patients, group 2). Postoperative reduction status, Cleveland index, Tip-apex distance and complications during the follow-up period was compared. Lag screw slippage and femoral neck-shaft angle change were measured between two groups.
RESULTS
No significant difference of reduction status, Cleveland index and Tip-apex distance was found. In group II, there was a 1 more case of cutting-out of the lag screw, but also there was a significant difference. Lesser change in lag screw slippage and neck-shaft angle change was investigated.
CONCLUSION
As there are lesser lag screw slippage and neck-shaft angle change, alternative bone substitutes applied in unstable intertrochanteric fractures seems to be useful in maintaining reduction and preventing failure of internal fixation when proper reduction and screw insertion is performed.
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Comparison of the Compression Hip Screw (CHS) and the Proximal Femoral Nail Antirotation (PFNA) for Intertrochanteric Femoral Fracture
Jong Min Lim, Jeung Il Kim, Jong Seok Oh, Kuen Tak Suh, Jae Min Ahn, Dong Joon Kang
J Korean Fract Soc 2010;23(4):360-366.   Published online October 31, 2010
DOI: https://doi.org/10.12671/jkfs.2010.23.4.360
AbstractAbstract PDF
PURPOSE
To evaluate the radiologic, clinical results between who had intertrochanteric fracture, treated with Compression Hip Screw (CHS) and Proximal Femoral Nail Antirotation (PFNA).
MATERIALS AND METHODS
We retrospectively reviewed each 36 and 48 patients of intertrochanteric fracture which were treated with CHS or PFNA by one surgeon from January 2005 to June 2009. We evaluated mean operation time, amount of bleeding, radiologic results, and the clinical outcomes with the mobility score of Parker and Palmer, social function scoring system.
RESULTS
The mean operation time, amount of bleeding were less in the PFNA group, there were 116.7 min, 486.1 ml for the CHS group versus 87.7 min, 289.6 ml for the PFNA group. The radiologic results were not significantly different. Decrease of mobility score of Parker and Palmer, social function score were similar. Proximal migration of leg screw and perforation of femoral head was 2 case and deep infection was 1 cases in CHS group.
CONCLUSION
There were no significant differences that are clinical and radiological results in treatment of intertrochanteric fracture using the CHS and PFNA. But PFNA is less invasive device than CHS, therefore it may be useful device in elderly patients.

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  • Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate
    Tae Woo Kim, Sang-Min Lee, Nam Hoon Moon, Won Chul Shin
    Injury.2021; 52(8): 2350.     CrossRef
  • Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients
    Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal
    Hip & Pelvis.2012; 24(1): 45.     CrossRef
  • Treatment of Intertrochanteric Fractures Using Targon Proximal Femoral Nails
    Il Ho Park, Jong Kyoung Won, Kye Young Han
    Hip & Pelvis.2012; 24(2): 117.     CrossRef
  • A Comparison of Intramedullary and Extramedullary Fixations for the Treatment of Reverse Oblique or Transverse Intertrochanteric Femoral Fractures
    Yerl-Bo Sung, Jung-Yun Choi, Eui-Yub Jung
    Hip & Pelvis.2012; 24(2): 109.     CrossRef
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Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate
Tae Ho Kim, Jong Oh Kim, Seung Yup Lee, Geon Ung Yun
J Korean Fract Soc 2010;23(4):353-359.   Published online October 31, 2010
DOI: https://doi.org/10.12671/jkfs.2010.23.4.353
AbstractAbstract PDF
PURPOSE
To evaluate the effectiveness of Proximal Femoral Nail Anti-rotation (PFNA) for the treatment of unstable intertrochanteric fracture comparing with Compression Hip Screw (CHS) with Trochanteric Stabilizing Plate (TSP).
MATERIALS AND METHODS
With clinical study, 43 patients who were treated surgically for unstable intertrochanteric fractures were retrospectively evaluated. One group was treated with CHS and TSP (Group 1, 22 cases) and the other was treated with PFNA (Group 2, 21 cases). By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Lag screw slippage, Neck-shaft angle change and Union time. And By retrospective medical record review, the clinical results were evaluated with the operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, walking ability change and complication.
RESULTS
There was a lower operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, lag screw slippage and neck shaft angle change in the Group 2 than in the Group 1 (p<0.05).
CONCLUSION
PFNA showed better results than CHS with TSP in operation time, estimated blood loss, amount of drainage and transfusion, lag screw slippage and neck-shaft angle change.

Citations

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  • Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures
    Bing Zhe Huang, Yong Wook Park, Jin Su Park, Kyu Cheol Noh, Soung Yon Kim, Kook Jin Chung, Hong Kyun Kim, Hyong Nyun Kim, Yong Hyun Yoon, Ji Hyo Hwang
    Journal of the Korean Fracture Society.2014; 27(3): 213.     CrossRef
  • Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
    Jae-Cheon Sim, Tae-Ho Kim, Ki-Do Hong, Sung-Sik Ha, Jong-Seong Lee
    Journal of the Korean Fracture Society.2013; 26(1): 37.     CrossRef
  • Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures
    Jee-Hoon Kim, Oog-Jin Shon
    Journal of the Korean Fracture Society.2013; 26(4): 305.     CrossRef
  • A Comparison between Compression Hip Screw and Intramedullary Nail for the Treatment of AO/OTA A2.2 Intertrochanteric Femoral Fracture
    Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Jong Hyun Kim
    Journal of the Korean Fracture Society.2013; 26(1): 44.     CrossRef
  • The Treatment of Intertrochanteric Femoral Fracture with Proximal Femoral Nail Antirotation
    Jong Won Kim, Hyun Soo Park, Young Soo Jang, Jae Hyuk Choi, Sung Ju Bae, Chan Il Bae
    Journal of the Korean Fracture Society.2012; 25(4): 257.     CrossRef
  • Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture
    Ki-Do Hong, Jae-Chun Sim, Sung-Sik Ha, Tae-Ho Kim, Yoon-Ho Choi, Jong-Hyun Kim
    Journal of the Korean Fracture Society.2011; 24(1): 7.     CrossRef
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Cementless Bipolar Hemiarthroplasty for Treating Intertrochanteric Fracture in Elderly Patients
Han Jun Lee, Jong Won Kim, Jae Sung Lee, Jae June Yang, Woo Young Hwang
J Korean Fract Soc 2010;23(3):276-281.   Published online July 31, 2010
DOI: https://doi.org/10.12671/jkfs.2010.23.3.276
AbstractAbstract PDF
PURPOSE
To evaluate clinicoradiological outcomes after cementless bipoloar hemiarthroplasty in elderly patients with femoral intertrochanteric fractures.
MATERIALS AND METHODS
From March 2006 to February 2008, 28 patients-all in patients greater than 80 years of age, classified unstable intertrochanteric fractures in Evans classification-were followed for more than 1 year. 24 patients were women and 4 patients were men. The mean age of the patients was 84.6 years, the mean follow-up period was 16.3 months. Harris hip score, postoperative inguinal and thigh pain, Parker and Palmer mobility score were analyzed clinically. The radiological results were assessed using various radiological indicies including bone-union, fit and alignment change of femoral stem and vertical subsidence.
RESULTS
The average Harris hip score was 82.9, Parker and Palmer mobility score preoperative 8.0 changed to 5.2 postoperatively. More than moderate pain was presented in 1 case. There were no cases of varus deformity or osteolysis. All stems were stable without significant alignment change or subsidence except 1 case of periprosthetic fracture. There were no dislocation, thromboembolism, death during operation or hospital days.
CONCLUSION
In elderly patients, cementless bipolar hemiarthroplasty is good treatment method of unstable intertrochanteric fracture and short-term clinicoradiological outcomes proved to be satisfactory.

Citations

Citations to this article as recorded by  
  • The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures
    Yee-Suk Kim, Jae-Seung Hur, Kyu-Tae Hwang, Il-Yong Choi, Young-Ho Kim
    Hip & Pelvis.2014; 26(2): 99.     CrossRef
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  • 1 Crossref
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