Young-Yool Chung; Dong-Hyuk Choi; Dae-Hyun Yoon; Jung-Ho Lee; Ji-Hun Park

doi:10.12671/jkfs.2015.28.2.103

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Original Article
Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal: Young-Yool Chung, M.D., Dong-Hyuk Choi, M.D., Dae-Hyun Yoon, M.D., Jung-Ho Lee, M.D., Ji-Hun Park, M.D.; Journal of the Korean Fracture Society 2015;28(2):103-109.
DOI: https://doi.org/10.12671/jkfs.2015.28.2.103
Published online: April 21, 2015

Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea.

Address reprint requests to: Young-Yool Chung, M.D. Department of Orthopaedic Surgery, Kwangju Christian Hospital, 37 Yangrim-ro, Nam-gu, Gwangju 503-715, Korea. Tel: 82-62-650-5064, Fax: 82-62-650-5066, paedic@chol.com

• Received: August 20, 2014 • Revised: September 27, 2014 • Accepted: January 28, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of this study is to analyze the clinical results of fixation using Sirus® 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® 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® 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.
Key words: Subtrochanteric fracture, Femoral shaft fractures, Intramedullary nailing, Sirus® nail, Entry point, Iatrogenic fracture

None.

REFERENCES

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4. Dora C, Leunig M, Beck M, Rothenfluh D, Ganz R. Entry point soft tissue damage in antegrade femoral nailing: a cadaver study. J Orthop Trauma, 2001;15:488-493.
5. Ansari Moein CM, Verhofstad MH, Bleys RL, van der Werken C. Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip. Injury, 2005;36:1337-1342.
6. Yun HH, Oh CH, Yi JW. Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture. Clin Orthop Surg, 2013;5:230-234.
7. Afsari A, Liporace F, Lindvall E, Infante A Jr, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg Am, 2009;91:1913-1918.
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Fig. 1

For estimation of proper entry portals, we assumed the length of Sirus® nail (s) to circular arc (EF). The radius (r) of the circle was informed by regular manufacturer's information. Finally we estimated the central angle (θ) from the circle and compared with contralateral neck-shaft angle.

Fig. 2

Illustration of subdivision by entry points. ①: Lateral entry point, ②: greater trochanter tip entry point, ③: medial entry point.

Fig. 3

Preoperative and postoperative antero-posterior view of iatrogenic fracture that occurred in Sirus® nail insertion using lateral entry point.

Table 1

Summary of Demographics

Values are presented as number (%) or median (range). ^*Two patients were injured with both subtrochanteric and segmental shaft fracture of femur.

Table 2

Comparison of Clinical Results and Complications between Subtrochanteric and Shaft Fracture of the Femur

Values are presented as median (range) or number (%). ^*Includes screw irritations, heterotrophic ossification, device loosening & breakage and limping gait with pain. ^†Mal-alignment was defined as more than or equal to 5 degrees of neck-shaft angle compared with contralateral of the subtrochanteric fractures in the coronal plane and 10 degrees of total angular deformity of the femoral shaft fractures in the coronal and sagittal planes, respectively.

Table 3

Comparison of Clinical Results between Entry Portals (n=36)

Values are presented as median (range) or number (%). ^*Includes screw irritations, heterotophic ossification, device loosening & breakage and limping gait with pain. ^†Mal-alignment was defined as more than or equal to 5 degrees of neck-shaft angle compared with contralateral of the subtrochanteric fractures in the coronal plane and 10 degrees of total angular deformity of the femoral shaft fractures in the coronal and sagittal planes, respectively.

Figure & Data

REFERENCES

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Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal

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

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Figure

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Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal

Fig. 1 For estimation of proper entry portals, we assumed the length of Sirus® nail (s) to circular arc (EF). The radius (r) of the circle was informed by regular manufacturer's information. Finally we estimated the central angle (θ) from the circle and compared with contralateral neck-shaft angle.

Fig. 2 Illustration of subdivision by entry points. ①: Lateral entry point, ②: greater trochanter tip entry point, ③: medial entry point.

Fig. 3 Preoperative and postoperative antero-posterior view of iatrogenic fracture that occurred in Sirus® nail insertion using lateral entry point.

Fig. 1

Fig. 2

Fig. 3

Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal

Table 1

Summary of Demographics

Values are presented as number (%) or median (range). ^*Two patients were injured with both subtrochanteric and segmental shaft fracture of femur.

Table 2

Comparison of Clinical Results and Complications between Subtrochanteric and Shaft Fracture of the Femur

Table 3

Comparison of Clinical Results between Entry Portals (n=36)

Table 1 Summary of Demographics

Values are presented as number (%) or median (range). ^*Two patients were injured with both subtrochanteric and segmental shaft fracture of femur.

Table 2 Comparison of Clinical Results and Complications between Subtrochanteric and Shaft Fracture of the Femur

Table 3 Comparison of Clinical Results between Entry Portals (n=36)