Journal of Musculoskeletal Trauma

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

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.

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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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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

Abstract 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.

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Periprosthetic Femur Fractures in Osseointegration Amputees
Jason Shih Hoellwarth, S. Robert Rozbruch
JBJS Case Connector.2022;[Epub] CrossRef

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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

Abstract 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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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

Abstract 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.

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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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Delayed Pseudoaneurysm of Deep Femoral Artery Caused by Migration of Lesser Trochanter, Subsequent to an Intertrochanteric Fracture Surgery - A Case Report -: Bum-Soo Kim, Seong-Tae Kim, Seungyup Shin, Chang Geun Yu; J Korean Fract Soc 2021;34(2):76-79. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.76

Abstract PDF: The lesser trochanteric fracture is commonly found amongst intertrochanteric fractures, where pseudoaneurysm of the femoral artery is a rare complication. A pseudoaneurysm could develop due to the penetration injury of the artery by the bone fragment during occurrence of the fracture, or by the insertion of screws during the surgical procedure. Minimal complication is seen when the lesser trochanter is not fixed during the intertrochanteric fracture surgery. However, in the current case, the authors experienced appearance of a delayed pseudoaneurysm of the deep femoral artery caused by migration of the lesser trochanter, which was successfully treated by excision.

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Injury of the Ascending Branch of the Lateral Femoral Circumflex Artery Caused by a Spike of the Displaced Lesser Trochanter in an Intertrochanteric Femoral Fracture - A Case Report -: Soon Ho Huh, Hong-Man Cho, Jiyeon Park; J Korean Fract Soc 2021;34(2):71-75. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.71

Abstract PDF: Although vascular injuries associated with femoral intertrochanteric fractures have been reported infrequently, bleeding due to vascular injury can lead to severe complications that can be potentially life and limb-threatening. The authors report a case of an injury of the ascending branch of the lateral femoral convolutional artery in a patient who underwent surgical treatment for a femoral intertrochanteric fracture. Vascular injury occurred due to the sharp margin of displaced lesser trochanter five weeks after surgery. Percutaneous transcatheter embolization was done and improved without additional complications. Therefore, the surgeons need to be aware of possible associated vascular injuries caused by displaced lesser trochanter fragments in femoral intertrochanteric fractures.

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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

Abstract 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

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Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?
Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
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

Abstract 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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Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture: Soo Jae Yim, Yong Bok Park, Hyun Kwon Kim, Sin Hyung Park; J Korean Fract Soc 2020;33(4):210-216. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.210

Abstract PDF: Purpose
This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures.
Materials and Methods
From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared.
Results
The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012).
Conclusion
The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.

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Rendezvous Surgery for Peri-Implant Fractures around Locking Compression Plate on Anterolateral Bowed Femur - A Case Report -: Hong Man Cho, Jiyeon Park; J Korean Fract Soc 2020;33(3):159-163. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.159

Abstract PDF: An 84-year-old female visited with an intertrochanteric femoral fracture. The patient had undergone an open reduction and internal fixation with a compressive plate and elastic nail in an ipsilateral atypical diaphyseal femoral fracture in the past. Compressive plate and elastic nail remained, and anterolateral bowing was presented. To treat the periprosthetic trochanteric fracture, a proximal femoral nail was used without removing the previously inserted compressive plate. Under the “rendezvous” technique, using a combination of fixating intramedullary nail and compressive plate simultaneously, the distal screw was fixed, and a femoral head lag screw was inserted after reducing the fracture. Complete union of the fracture was achieved 16 months after the operation, and a decrease in mobility function was not found postoperatively. The authors report this case for the “rendezvous” technique as a treatment option for elderly patients with periprosthetic trochanteric fractures, who had previously undergone surgical treatment for ipsilateral atypical diaphyseal femoral fractures with anterolateral bowing.

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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

Abstract 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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Failure of Intramedullary Nailing for Subtrochanteric Atypical Femoral Fractures Caused by Endosteal Cortical Thickening: Young Ho Roh, Kimoon Kang, Hee Joong Kim, Kwang Woo Nam; J Korean Fract Soc 2019;32(4):211-221. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.211; Correction in: J Musculoskelet Trauma 2020;33(1):63

Abstract PDF

PURPOSE
Recent literature has noted incidences of subtrochanteric atypical femoral fractures (AFFs) in patients who have taken long-term bisphosphonates (BPs). Most cases of subtrochanteric AFFs have been treated with intramedullary nailing and cases of delayed union have been reported. On the other hand, there is no data available on the complications associated with endosteal thickening or cortical thickening. This study evaluated the results of surgical treatment according to the endosteal thickening of the lateral cortex in subtrochanteric AFFs.
MATERIALS AND METHODS
Investigation was performed at the Department of Orthopaedic Surgery, Jeju National University Hospital. The study consisted of patients with subtrochanteric AFFs, defined by the American Society for Bone and Mineral Research (ASBMR) major criteria, who underwent intramedullary nailing from March 2012 to October 2014. The cases were categorized into two groups based on the presence of endosteal thickening. The evaluation included the demographic data, radiographic data of initial reduction state, and duration of BPs.
RESULTS
The demographic data and duration of BPs were similar in the two groups. On the other hand, varus reduction (Group I: 12.5% vs. Group II: 78.9%; p=0.001), delayed union (Group I: 0% vs. Group II: 70.0%; p=0.003), nonunion (Group I: 0% vs. Group II: 47.4%; p=0.017), and union time (Group I: 5.5 months vs. Group II: 8.3 months; p<0.001) were significantly different in the two groups.
CONCLUSION
Endosteal thickening of the lateral cortex in subtrochanteric AFFs was identified as an independent factor that decides the reduction of the fracture and nonunion. The endosteal thickening should be removed to obtain anatomical alignment for successful surgical results.

Citations

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Controlled bending of proximal femoral nails used in fractures of bowed femurs: biomechanical study with clinical application
Hong Moon Sohn, Suenghwan Jo
Medical Biological Science and Engineering.2022; 5(2): 63. CrossRef

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Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note: Gyu Min Kong; J Korean Fract Soc 2019;32(2):107-111. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.107

Abstract PDF: The subtrochanteric area is the place where mechanical stress is most concentrated in the femur. When a fracture happens, bone union is delayed and nonunion often occurs. The recommended treatment for atypical fractures is an anatomical reduction of the fracture site as the frequency of nonunion is higher than that of ordinary fractures. Various reduction methods have been suggested, and good results have been obtained. On the other hand, the occurrence of posterior displacement of the distal fragment during the insertion of an intramedullary nail is often overlooked. This is probably because the bone marrow of the femur tends to form an elliptical shape in the anteroposterior direction. The author attempted to insert a blocking screw into the distal part of the fracture to prevent posterior displacement of the distal fragment while performing intramedullary nailing of the femur fracture and achieved a good reduction state easily.

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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

Abstract 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 NÂ·mm vs. 14,751.0 NÂ·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.

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Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?
Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
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
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Wenjun Xie, Liu Shi, Cheng Zhang, Xueliang Cui, Xiangxu Chen, Tian Xie, Sheng Zhang, Hui Chen, Yunfeng Rui
Injury.2024; 55(12): 111926. CrossRef
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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
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Seok Ha Hong, Kang Hun Yu, Seung Beom Han
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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
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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
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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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

Abstract 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.

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Medial lag screw migration in an intramedullary nail combination
Zac Dragan, Ryan J Campbell, Terence R Moopanar
BMJ Case Reports.2025; 18(3): e262436. CrossRef
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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Comparison of the Treatment Results between Reduction with Percutaneous Wiring and Reduction without Percutaneous Wiring in Reverse Oblique Trochanteric Fractures (AO Classification 31-A3.3): Jae Woo Park, Oog Jin Shon, Seung Wan Lim; J Korean Fract Soc 2017;30(4):192-197. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.192

Abstract PDF: PURPOSE
The aim of this study was to investigate the utility of percutaneous wiring in the reduction of reverse oblique trochanteric fractures (AO classification 31-A3.3) by analyzing the treatment results with or without the use of percutaneous wiring.
MATERIALS AND METHODS
Thirty-five cases from January 2008 to August 2014 that could be followed-up for at least one year were selected among patients with unstable trochanteric fractures who underwent either internal fixation or open reduction. Seventeen patients underwent surgery with percutaneous wire fixation but another 18 patients underwent surgery without it. All patients received a closed reduction and internal fixation with an intramedullary nail. The factors evaluated were as follows: the length of operation, loss of blood, length of in-hospital stay, lower limb function scale, return to preinjury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, time taken for bone attachment, quality of post-operative reduction, and complications.
RESULTS
No significant difference in the mean operative time, loss of blood, length of in hospital stay, lower limb function scale, return to pre-injury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, and quality of postoperative reduction was observed between the two groups. A significant difference was noted in the time taken for bone attachment (p=0.032). Bone attachment took 13.3 weeks (9â€“17 weeks) on average when fixed with percutaneous wiring and no patient was found to have any complications. When treated without percutaneous wiring, however, bone attachment took 17.8 weeks (12.5â€“28.0 weeks) on average and three cases resulted in delayed union.
CONCLUSION
Percutaneous wiring is a recommended treatment option for patients with an unstable trochanteric fracture.

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The Determination of Optimal Entry Point for Proximal Femoral Nail Antirotation-II by Fluoroscopic Simulation: A Cadaveric Study: Jin Hoon Jeong, Gu Hee Jung; J Korean Fract Soc 2017;30(4):173-179. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.173

Abstract PDF

PURPOSE
This study seeks to determine the anatomically optimal entry point of proximal femoral nail antirotation-II (PFNA-IIÂ®) according to geographic features of Korean cadaveric femoral trochanters for successful reduction of osteoporotic proximal femoral fractures.
MATERIALS AND METHODS
Forty-three adult cadaveric femurs without previous fractures or surgeries were included. Anteroposterior (AP) and lateral images of all femurs and PFNA-IIÂ® were taken with an image intensifier. Using the image synthesis process via the image editing program (Adobe Photoshop CS6), the optimal entry point was verified and compared with the tip of the greater trochanter (GT) and the cervicotro-chanteric junction on AP images, as well as the width of the trochanter and the neck on lateral images.
RESULTS
The optimal entry point of PFNA-IIÂ® was an average distance of 9.1 mm (range, 7â€“15 mm) medially from the tip of GT on AP images. The center of the nail was located at an average of 30% (range, 21%â€“44%) area from the posterior margin of the middle neck, which is an average area of 38% (range, 26%â€“48%) from the posterior cortex of the trochanter on lateral images. Furthermore, the ideal entry point was at the extended line of the cervico-trochanteric junction.
CONCLUSION
The optimal entry point, which was found to be medial to the tip of the GT and posterior to the center of the middle femoral neck and the trochanter, was at on the extended line of the cervicotrochanteric junction.

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Clinical Research through Computational Anatomy and Virtual Fixation
Ju Yeong Kim, Dong-Geun Kang, Gu-Hee Jung
Journal of the Korean Orthopaedic Association.2023; 58(4): 299. CrossRef
Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study
Chittawee Jiamton, Nonpawit Nimmankiatkul, Pongsakorn Rungchamrassopa, Wichan Kanchanatawan, Pariyut Chiarapatanakom, Wirat Kongcharoensombat
Journal of Southeast Asian Orthopaedics.2022;[Epub] CrossRef

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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; J Korean Fract Soc 2016;29(4):250-257. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.250

Abstract PDF: PURPOSE
The purpose of this study was to introduce our method of stabilizing unstable intertrochanteric fractures by using the dynamic hip screw (DHS) with a beta-tricalcium phosphate (Î²-TCP) graft and to compare the outcomes of this procedure with those of the conventional DHS without Î²-TCP.
MATERIALS AND METHODS
Patients who underwent surgery by using DHS between March 2002 and January 2016 were retrospectively reviewed for analysis of the outcomes. The inclusion criteria were: 1) age of 60 years and older; 2) low-energy fracture resulting from a fall from no greater than the standing height; 3) multifragmentary pertrochanteric fracture (AO classification 31-A2.2, 2.3); and 4) follow-up of over 3 months. We compared 29 patients (29 hips) who underwent surgery, using DHS without Î²-TCP, with 29 age-sex matched patients (29 hips) who underwent surgery using DHS with grafted Î²-TCP granules to empty the trochanter area after reaming. We investigated the fracture union rate, union time, and length of lag screw sliding.
RESULTS
Bone union was achieved in all cases. The mean union time was 7.0 weeks in the Î²-TCP group and 8 .8 weeks in the non-Î²-TCP group. The length of lag screw sliding was 3.6 mm in the Î²-TCP group and 5 .5 mm in the non-Î²-TCP group. There were no implant failure cases in both groups.
CONCLUSION
The Î²-TCP graft for reinforcement DHS acquired satisfactory clinical outcomes for treating unstable intertrochanteric fractures.

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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

Abstract 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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Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph: Suc Hyun Kweon, Jin Yeong Park, Seng Hwan Kook, Byung Min Yoo; J Korean Fract Soc 2016;29(3):171-177. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.171

Abstract PDF: PURPOSE
The purpose of this study was to compare the sliding distance of lag screw in patients with unstable femoral intertrochanteric fractures treated with intramedullary fixation using a cephalomedullary nail with a fixed angle between the neck and shaft of the femur in relation to reduction type by lateral radiographs.
MATERIALS AND METHODS
Between January 2009 to October 2013, 86 cases (86 patients) with unstable femoral intertrochanteric fractures were treated with intramedullary fixation using a metal nail with a fixed neck-shaft angle and followed for at least 6 months. We used AO/OTA classification, and all cases were unstable fractures. Twenty cases were 31-A22, 54 cases were 31-A23, and 12 cases were 31-A3. There were 30 men and 56 women. Average patient age was 73.7 years (range, 47-97 years). We classified reduction types into three groups as postoperative lateral radiologic findings. Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displacement of the femur neck. The radiological assessment compared the sliding distance of the lag screw between postoperative X-ray and last follow-up X-ray.
RESULTS
Forty-two cases were in group 1, 22 cases were in group 2, and the other 22 cases were in group 3. There was no significant difference in the patient characteristics of each group. The sliding distances of the lag screw were 4.9Â±3.2 mm, 4.6Â±3.6 mm, and 8.5Â±4.9 mm, respectively, and group 3 showed a significant result (p<0.0001, p=0.024).
CONCLUSION
In cases treated with intramedullary fixation using a cephalomedullary nail with a fixed neck-shaft angle, appropriate reduction with a lateral radiograph before screw fixation is needed to prevent excessive lag screw sliding.

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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

Abstract 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.

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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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Assessment of Coronal Plane Malalignment Following Reduction of Trochanteric Fractures-Simple Intraoperative Guideline Using Greater Trochanter Orthogonal Line: Young Cheol Yoon, Jong Keon Oh, Won Yong Shon, Han Ju Kim, Jae Woo Cho; J Korean Fract Soc 2016;29(1):1-11. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.1

Abstract PDF: PURPOSE
There is no consensus on a clear intraoperative guideline for judging the coronal plane alignment following reduction of trochanteric fractures. Complex angular measurements using fluoroscope monitors are tedious. Therefore the relation of the horizontal line from the tip of the greater trochanter (GT orthogonal) and femur head center (HC orthogonal) was studied to define this line as a criterion for predicting varus-valgus malalignment.
MATERIALS AND METHODS
We studied this relation in 200 standing orthoradiograms which included 100 males and 100 females. The images were digitally analyzed using the picture archiving and communication system. GT orthogonal line and HC orthogonal line were evaluated. The distance of these lines was measured as trochanter center distance (TCD) and its correlation with angular parameters like neck shaft angle, medial proximal femoral angle with reference to anatomical axis (aMPFA) and lateral proximal femoral angle with reference to mechanical axis (mLPFA) were analyzed.
RESULTS
In all patients, the GT orthogonal line passed either at or above the center of the head. Overall mean of TCD was 7.22 mm, ranging from 0 to 17.57 mm. TCD was found to show strong correlation with angular parameters like aMPFA, mLPFA and neck shaft angle. TCD was less than one fourth of the corresponding head diameter in around 90%. Therefore following reduction of trochanteric fractures, the GT orthogonal line should pass through the superior juxta central quadrant of the femoral head.
CONCLUSION
This line can be represented by a guide wire with fluoroscopy during surgery. The GT orthogonal line can be used intraoperatively as a simplified tool for prediction of varus/valgus malalignment following the reduction of trochanteric fractures.

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Iatrogenic Subtrochanteric Fractures Related to the Surgical Error: Two Cases Report: Kook Jin Chung, June Young Jeon, Hyun Woo Na, Ji Hyo Hwang; J Korean Fract Soc 2015;28(4):250-255. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.250

Abstract PDF

Iatrogenic fracture is not popular and might be recognized as a malpractice. Surgical error related to iatrogenic fracture which has occurred after an operation can be detected only by a surgeon. Stress riser fracture is another form of iatrogenic fracture also known as a Young's modulus fracture. As the majority of surgical related stress riser fractures can be preventive, the accurate prevalence is not known. The majority of fractures occurred in the weight bearing bones such as femur and tibia. The subtrochanter area is the most stress concentrated area in the human body, thus it is a common area for occurrence of stress riser iatrogenic fractures. We experienced 2 cases of stress riser iatrogenic fractures, which are related to technical errors, thus we report cases with literature review.

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Mechanical and Physical Characteristics Analysis of Radius Trauma Plate by EBM Additive Manufacturing
Kwun-Mook Lim, Sung-Jun Park
Journal of the Korean Society of Manufacturing Technology Engineers.2020; 29(2): 147. CrossRef

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Analysis of Low-Energy Trochanter Fracture Using the Multiplanar Computed Tomography Image: Application for Intramedullary Nail Fixation: Gu Hee Jung, Sung Keun Heo, Hyun Je Seo; J Korean Fract Soc 2015;28(3):155-162. Published online July 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.3.155

Abstract PDF: PURPOSE
The purpose of this radiologic study was to evaluate the geographic patterns of low-energy trochanteric fractures using multiplanar computed tomography (CT) images for application of intramedullary nailing.
MATERIALS AND METHODS
In this study, 117 trochanteric fractures (stable fracture, 39 cases, unstable fractures, 78 cases) sustained from simple slip-down were assessed. The mean age was 78.4 years (range, 60-96 years). Multiplanar CT images were assessed for evaluation of geographic features of trochanteric fracture, and the fracture exit and geographic patterns were analyzed.
RESULTS
The medial and lateral exit of the trochanteric fracture showed no statistical difference by age, bone density, and comorbid disease. The exit was located at an average distance of 10.2 mm (range, 1.0-22.2 mm) from the tip of the greater trochanter (GT), and the medial exit, average distance of 8.1 mm (range, 0.0-18.3 mm) from the tip of the lesser trochanter. It was also found that there was no comminution around the anteromedial cortex of the fracture, and its contact loss was from fracture deformity.
CONCLUSION
Because of no comminution, the contact restoration of the anteromedial cortex resulted in correction of fracture deformity and reduction. Trochanteric nailing by GT tip could be fixed through the proximal fragment of the fracture because the lateral exit is placed at an average distance of 10.2 mm from the GT tip.

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Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal: Young Yool Chung, Dong Hyuk Choi, Dae Hyun Yoon, Jung Ho Lee, Ji Hun Park; J Korean Fract Soc 2015;28(2):103-109. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.103

Abstract PDF: PURPOSE
The purpose of this study is to analyze the clinical results of fixation using Sirus(R) nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal.
MATERIALS AND METHODS
From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus(R) nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared.
RESULTS
The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment.
CONCLUSION
Using Sirus(R) nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

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Failure to Remove a Trochanteric Entry Femoral Nail and Its Cause in Adolescent Patients: Two Cases Report: Ji Hwan Kim, Seung Oh Nam, Young Soo Byun, Han Sang Kim; J Korean Fract Soc 2015;28(1):71-76. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.71

Abstract PDF: Trochanteric entry femoral nails have been widely used for fixation of femoral shaft fractures because of easier identification of the entry point. Young patients usually request removal of the nail after healing of the fracture. We experienced a failure and difficulty in removal of the trochanteric entry nail in two adolescent patients. In the patient in which the nail could be removed with difficulty, dense compact bone was formed through the empty interlocking holes and the nail was held just like a latch. This finding was quite similar to the computed tomography findings of the patient in which the nail could not be removed. In order to remove the nail, the newly formed, dense compact bone in the interlocking holes must be broken and detached from the femur itself. We suggest that dense compact bone through the empty interlocking holes might be a clue for difficult removal of the trochanteric entry nail.

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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

Abstract 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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Steinmann Pin Assisted Reduction of Subtrochanteric Femoral Fracture: Seung Wan Lim, Oog Jin Shon; J Korean Fract Soc 2015;28(1):17-22. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.17

Abstract PDF

PURPOSE
Nail insertion is the treatment of choice for subtrochanteric femoral fracture, but displacement of proximal bone fragment makes it difficult to find an ideal entry point. Therefore, in this study we aimed to determine the usefulness of treatment of subtrochanteric femoral fracture using Steinmann pin assisted reduction, internal fixation, and insertion of intramedullary nails.
MATERIALS AND METHODS
We evaluated 33 patients who were followed-up more than a year with a displaced subtrochanteric femoral fracture treated with closed reduction and intramedullary nail fixation between January 2008 and March 2013. In addition, we studied postoperative bone union time, postoperative reduction status, change of the femur neck shaft angle, evaluation of hip joint function, return to daily life, and complications.
RESULTS
All fractures with Steinmann pin assisted reduction were united but they included three cases of delayed union. In Fogagnolo classification, all cases were up to acceptable states and the varus change of femur neck shaft angle was 0.94degrees+/-3.1degrees; no significant difference in Harris hip score was observed between preoperative and last follow-up (p>0.05).
CONCLUSION
There were satisfactory results in bone union and reduction state with Steinmann pin assisted reduction. Therefore, Steinmann pin assisted reduction is a useful surgical technique for subtrochanteric femoral fracture.

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Percutaneous acetabular anchoring pin-assisted cephalomedullary nailing for subtrochanteric and unstable intertrochanteric fractures
Keong-Hwan Kim, Youngsik Yoon, Eic Ju Lim
Injury.2020; 51(3): 769. CrossRef

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Removal Methods for Broken Proximal Femoral Nails Using Ball Tip Guide Wire: Technical Note and Two Cases Report: Bong Ju Park, Hong Man Cho; J Korean Fract Soc 2014;27(4):315-320. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.315

Abstract PDF

Recently, the use of intramedullary nailing for proximal femoral fractures has increased. Breakage of the nail usually occurs at the un-united fracture site, and it is a rare complication of intramedullary nailing of the femur. However, removal of the distal fragment of a broken nail is a challenging problem. Herein, the authors describe the methods used for removal of relatively fixed or strongly fixed broken intramedullary nails in two different cases.

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Breakage of the Tail Portion of the Lag Screw during Removal of Proximal Femoral Zimmer Natural Nail: Report of Two Cases with Technical Notes
Asep Santoso, Ik-Sun Choi, Kyung-Soon Park, Taek-Rim Yoon
Hip & Pelvis.2017; 29(3): 199. CrossRef

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Comparison of Greater Trochanter Versus Piriformis Entry Nail for Treatment of Femur Shaft Fracture: Jong Hee Lee, Jong Hoon Park, Si Yeong Park, Seong Cheol Park, Seung Beom Han; J Korean Fract Soc 2014;27(4):287-293. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.287

Abstract PDF: PURPOSE
The purpose of this study was to compare the clinical outcome of femoral shaft fracture treatment with intramedullary nailing performed using a greater trochanter and a piriformis entry nail.
MATERIALS AND METHODS
A total of 57 patients treated by antegrade nailing for a femoral shaft fracture between January 2008 and April 2013 were included in this study. We evaluated postoperative radiographs of 57 femoral shaft fractures stabilized with femoral intramedullary nailing at a single institutional center. The cases included 25 piriformis fossa entry nails and 32 greater trochanter entry nails. Outcome measures included the alignment, union rate and duration of union, complications, operation time, intra-operative bleeding, and a pain rating scale.
RESULTS
The alignment, union rate, and duration of union did not differ significantly between the groups with piriformis fossa and trochanteric nailing. In addition, no significant differences regarding complications and operation time were observed between the two groups. Less intra-operative bleeding was observed in the trochanteric nailing group. This difference was statistically significant (p=0.044).
CONCLUSION
Use of a femoral nail specially designed for the trochanteric insertion resulted in equally high union rates, duration of union, and low complication rates. Thus, greater trochanter entry nails were similar to conventional antegrade femoral nailing through the piriformis fossa.

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