Journal of Musculoskeletal Trauma

Deep Femoral Vessel Injury Following Subtrochanteric Hip Fracture: A Case Report: Jae Hyuk Yang, Jung Ro Yoon, Kyu Bok Kang, Ho Hyun Yun, Young Soo Shin, Yun Ku Cho; J Korean Fract Soc 2012;25(1):64-68. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.64

Arterial trauma associated with hip fracture treatment is still a rare complication. We present a case in which an arterial injury was discovered during closed reduction and intramedullary nail fixation of a subtrochanteric hip fracture. The preoperative thigh circumference was increased due to severe swelling, and the vascular injury was located substantially proximal to the fracture and the instrumentation area. An interventional angiogram revealed a damaged vessel originating from one of the minor proximal branches of the right deep femoral artery while filling a 2 cm-sized pseudoaneurysm. Embolization was performed without further complications.

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Proximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes
Antonio Barquet, Andrés Gelink, Peter V. Giannoudis
Injury.2015; 46(12): 2297. CrossRef
Pertrochanteric Hip Fracture: A “Routine” Fracture With a Potentially Devastating Vascular Complication
Matthew Patrick Sullivan, Mara Lynne Schenker, Samir Mehta
Orthopedics.2015;[Epub] CrossRef

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Treatment of Comminuted Subtrochanteric Fractures of the Femur by High-Energy Trauma: Taek Soo Jeon, Woo Sik Kim, Sang Bume Kim, Cheol Mog Hwang, Kyu Tae Kim, Sun Hong Kim; J Korean Fract Soc 2006;19(2):135-140. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.135

Abstract

PURPOSE
The purpose is to evaluate the effectiveness of open reduction and internal fixation in comminuted subtrochanteric fractures caused by high energy trauma at a non-osteoporotic young age.
MATERIALS AND METHODS
Of all cases of subtrochanteric fractures caused by high energy trauma under 60 years old from February 2000 to February 2004, we analyzed 16 patients who had severe comminuted fractures (Seinsheimer classification type IV, V). The mean age is 43.5 (31~54) years old. Mean follow-up period was 22 (14~38) months. We tried to reduce anatomically as much as possible and fixed firmly using a compression hip screw in all cases. Additional procedures such as interfragmentary screw fixation, cerclage wiring or lateral stabilization plating were performed in 13 cases. Bone grafting was performed in 8 cases. We evaluated bony union rate, time to union, status of reduction, varus deformity and rate of implant failure using a simple X-ray. We also analyzed the clinical result using the Harris hip score including range of motion, pain and limping gait, so on.
RESULTS
In all 16 cases, bony union was achieved and the mean time to union was 24 (20~32) weeks. There was no intra-operative complication. Postoperative complications such as loss of reduction, varus deformity, implant failure or infection did not occur. Clinically, the Harris hip score was 98.9 (97~100) points.
CONCLUSION
Optimal open reduction and firm internal fixation with or without additional fixation was thought to be a recommendable method of treatment for comminuted subtrochanteric fractures of the femur caused by high energy trauma at a young age.

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Treatment of Subtrochanteric Femur Fractures Using Intramedullary Devices
Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Chong Suk Park, Sang Ho Lee
Journal of the Korean Fracture Society.2008; 21(1): 13. CrossRef

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Treatment of Comminuted Subtrochanteric Fractures of the Femur with Compression Hip Screw: You Sung Suh, Suk Bum Lim, Hyung Suk Choi, Yon Il Kim, Soo Kyoon Rah, Byung Ill Lee; J Korean Soc Fract 2001;14(2):181-188. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.181

Abstract PDF: PURPOSE
This study was performed to analyze the weight-bearing ambulation time, bony union time and complications after fixation of comminuted subtrochanteric fractures of the femur with compression hip screw and evaluate its effectiveness. MATERIAL & METHODS: From January 1993 to January 2000, 21 cases of S e i n s h e i m e r's Type IV and Type V comminuted subtrochanteric fractures of femur which were treated by compression hip screw and followed for more than 1 year were analyzed by weight-bearing ambulation time, bony union time and complications.
RESULTS
We recommended partial weight bearing ambulation from 6 weeks after operation and full weight bearing ambulation from 12 weeks after operation. All of 21 cases, primary bony union was achieved and mean time was 16 weeks(range 13 to 25 weeks). 2 cases of mechanical complications were occurred. Also 4 cases of malunion of lesser trochanter and 2 cases of nonunion of lesser trochanter were occurred, but none of them result in limitation of motion, limping nor pain.
CONCLUSIONS
We thought compression hip screw is a good implant for rigid fixation of comminuted subtrochanteric fractures, especially involve intertrochanteric region like Seinsheimer's Type IV and Type V.

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The Operative Treatment of Subtrochanteric Fractures of the Femur: Sang Won Park, Young Soo Byun, Dang Jae Lim; J Korean Soc Fract 1999;12(4):818-823. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.818

Abstract PDF: PURPOSE
: The authort have investigated the subtrochanteric fractures, which were treated operatively using variable internal fixation devices to determine the clinical results according to the fracture types and internal fixation devices.
MATERIALS and METHODS
: We have reported 18 cases of subtrochanteric fractures, which were treated operatively using variable internal fixation devices from October, 1992 to December, 1997. fourteen cases were male and 4 cases were female. Eight cases were type I, 5 cases were type II and 5 cases were type III by Fieldings classification. Of fixation devices, 13 cases were DHS, and 5 cases were interlocking intramedullary nail. The mean duration of follow up was 1 year and 6 months.
RESULTS
The mean duration of bony union was 20.3 weeks, and there was no significant difference between fracture types or between internal fixation devices. Of the 18 cases, 4 complications(22%) were occured ; delayed union(1 case), nonunion(1 case), and varus deformity(2 cases).
CONCLUSION
: The internal fixation devices should be chosen adequately according to the fracture type in subtrochanteric fracture of the femur. Also, additional bone graft was necessary for posteromedial cortical defect to decrease complications, in cases of nail-plate devices especially.

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Operative Treatment of Subtrochonteric Fractures of the Femur: Sang Ho Ha, Sang Hong Lee, Young Bae Pyo, Yong Hyun Jeon; J Korean Soc Fract 1995;8(3):513-520. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.513

Abstract PDF

The reduction and maintenance of subtrochanteric fractures are difficult because most of these fractures are comminuted due to high velocity trauma. Although various devices of internal fixation have been developed to solve these problems, selecting the appropriate fixation device for different fracture types is difficult. Subtrochanteric fractures were treated operatively and analysed at Chosun University hospital from Jan.1985 to Dec.1991 and the following results were obtained. The most common type of fracture was type II a by Seinsheimer classification(11 cases,28.9%) The bone union rate was 81.8% in plate fixation group and 87.5% in intramedullary group. Of the 38 cases, 9 complications occured. From this study, it was concluded that intramedullary nailing is beneficial in subtrochanteric fractures associated with medial cortical comminution. Also, when plating was performed massive bone grafting & external support were required.

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On the role of the pre-ionization mechanism in the optical breakdown of molecular oxygen induced by CO2 laser: Numerical investigation
Yosr E. E.-D. Gamal, O. Aied Nassef, A. S. Salama
Physics of Plasmas.2019;[Epub] CrossRef

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