Gu-Hee Jung

doi:10.12671/jkfs.2011.24.3.223

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Original Article
Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation: Gu-Hee Jung, M.D.; Journal of the Korean Fracture Society 2011;24(3):223-229.
DOI: https://doi.org/10.12671/jkfs.2011.24.3.223
Published online: July 15, 2011

Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea.

Address reprint requests to: Gu-Hee Jung, M.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 34, Amnam-dong, Seo-gu, Busan 602-030, Korea. Tel: 82-51-990-6785, Fax: 82-51-243-0181, jyujin2001@kosin.ac.kr

• Received: September 3, 2010 • Revised: December 7, 2010 • Accepted: April 11, 2011

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Abstract
REFERENCES

Abstract

Purpose
To evaluate the efficiency of provisional K-wire fixation in intertrochanteric fractures treated with proximal femoral nail (PFN).
Materials and Methods
Twenty seven patients (by AO/OTA classification, A1 8 cases, A2 19 cases) were treated with PFN with percutaneous reduction and provisional K-wire fixation, and followed a mean 24.5 months. The adequacy of fracture reduction was assessed by Fogagnolo's classification and reestablishment of bone-to-bone contact with the medial anatomy. Functional results were evaluated by postoperative complications, Jensen's method and Harris hip score (HHS).
Results
In all cases, the bone-to-bone contact with the medial anatomy was reestablished by percutaneous reduction and examination of Fogagnolo's classification showed a good reduction. The technical complications and error of starting point were not occurred. The mean HHS was 76.5 and means Jensen's grade was 2.1 grades. Complications included excessive sliding in 1 case and early cutting-out of screw in 1 case.
Conclusion
The provisional K-wire fixation in trochanteric fracture treated with PFN had an advantage in preventing technical complications because it facilitates a nail insertion in ideal position.
Key words: Femur, Trochanteric fracture, Provisional K-wire fixation, Proximal femoral nail

REFERENCES

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Fig. 1

Percutaneous reduction technique.

(A~C) The medial anatomy was reduced directly by pushing the proximal fragment using the ball-spike instrument.

(D, E) A fracture of greater trochanter was percutaneously reduced and fixed with K-wire.

(F) The intertrochatneric fracture was provisionally fixed with K-wires.

(G~I) The overlap of the head and neck fragment from the shaft was disimpacted using the Langenbeck elevator.

Fig. 2

Surgical Technique.

(A~C) After percutaneous reduction and provisional K-wires fixation, the reamer for lag screw was firstly inserted to make the entry portal and then, reamer for nail.

(D, E) the K-wire was removed during nail insertion.

(F, G) After nail insertion, the reduction was lost and provisionally fixed with K-wire for reduction.

(H) The lag screw was inserted in deep and central area of femoral head.

Fig. 3

Clinical photo revealed the nail insertion through minimal incision after provisional K-wire fixation and percutaneous reduction.

Fig. 4

(A) Initial radiographs showed the transverse intertrochanteric fracture.

(B, C) The postoperative radiographs showed a good reduction and accurate point of nail insertion but the lag screw was not located in deep area of the femoral head (TAD=37.2 mm).

(D) After 7 days, the lag screw was penetrated the femoral head and the fracture was collapsed.

(E, F) the lag screw was revised.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

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
Journal of the Korean Fracture Society.2015; 28(3): 155. CrossRef
Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures
Se-Ang Jang, Young-Ho Cho, Young-Soo Byun, Ki-Hong Park, Hyun-Seong Yoo, Chul Jung
Journal of the Korean Fracture Society.2013; 26(3): 199. CrossRef

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Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation

J Korean Fract Soc. 2011;24(3):223-229. Published online July 31, 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.3.223

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Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation

Fig. 1 Percutaneous reduction technique. (A~C) The medial anatomy was reduced directly by pushing the proximal fragment using the ball-spike instrument. (D, E) A fracture of greater trochanter was percutaneously reduced and fixed with K-wire. (F) The intertrochatneric fracture was provisionally fixed with K-wires. (G~I) The overlap of the head and neck fragment from the shaft was disimpacted using the Langenbeck elevator.

Fig. 2 Surgical Technique. (A~C) After percutaneous reduction and provisional K-wires fixation, the reamer for lag screw was firstly inserted to make the entry portal and then, reamer for nail. (D, E) the K-wire was removed during nail insertion. (F, G) After nail insertion, the reduction was lost and provisionally fixed with K-wire for reduction. (H) The lag screw was inserted in deep and central area of femoral head.

Fig. 3 Clinical photo revealed the nail insertion through minimal incision after provisional K-wire fixation and percutaneous reduction.

Fig. 4 (A) Initial radiographs showed the transverse intertrochanteric fracture. (B, C) The postoperative radiographs showed a good reduction and accurate point of nail insertion but the lag screw was not located in deep area of the femoral head (TAD=37.2 mm). (D) After 7 days, the lag screw was penetrated the femoral head and the fracture was collapsed. (E, F) the lag screw was revised.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation