Chi Hyoung Pak; Sang Hong Lee; Sang Ho Ha; Gwang Chul Lee; Kyoung Chul Song

doi:10.12671/jkfs.2013.26.4.284

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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation: Chi Hyoung Pak, M.D., Sang Hong Lee, M.D., Sang Ho Ha, M.D., Gwang Chul Lee, M.D., Kyoung Chul Song, M.D.; Journal of the Korean Fracture Society 2013;26(4):284-291.
DOI: https://doi.org/10.12671/jkfs.2013.26.4.284
Published online: October 18, 2013

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Sang Hong Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, shalee@chosun.ac.kr

• Received: June 10, 2013 • Revised: July 3, 2013 • Accepted: August 14, 2013

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 was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA).
Materials and Methods
Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication.
Results
Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion.
Conclusion
With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.
Key words: Femur, Subtrochanteric fracture, Proximal femoral nail anti-rotation

The present study was supported by grants from the Clinical Medicine Research Institute at Chosun University Hospital.

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Fig. 1

(A) Preoperative radiograph shows comminution subtrochanteric fracture of a 61-year-old male from a 2 m fall.

(B-D) The fracture was reduced satisfactorily using percutaneous reduction forceps to reverse the deforming forces.

(E-G) After using limited open incision, bone hook is maintained in place until a lag screw guide pin is placed in the proper position of the femoral head to prevent recurrence of flexion deformity.

(H, I) Postoperative hip anteroposterior and lateral view show a well-reduced subtrochanteric fracture treated with a single large lag-screw cephalomedullary device.

Fig. 2

(A-C) Initial hip Anteroposterior view, hip joint lateral and pelvis computed tomography images show a spiral subtrochanteric fracture of the femur with a large fragment.

(D, E) The fracture was reduced satisfactorily using cable grip and proximal femoral nail antirotation after surgery.

(F, G) Fracture healing is evident 1 year after surgery.

(H, I) Limited open reduction through a small incision with cable grip was done before nail insertion.

Table 1

Katz Activities of Daily Living Index

Independence: 1, Dependence: 0.

Table 2

Koval Score

Table 3

Comparison of Results for Comminution, Reduction Method, Cleveland Index

Nonunion: 2 cases.

Figure & Data

REFERENCES

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Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note
Gyu Min Kong
Journal of the Korean Fracture Society.2019; 32(2): 107. CrossRef

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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

J Korean Fract Soc. 2013;26(4):284-291. Published online October 31, 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.4.284

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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

Fig. 1 (A) Preoperative radiograph shows comminution subtrochanteric fracture of a 61-year-old male from a 2 m fall. (B-D) The fracture was reduced satisfactorily using percutaneous reduction forceps to reverse the deforming forces. (E-G) After using limited open incision, bone hook is maintained in place until a lag screw guide pin is placed in the proper position of the femoral head to prevent recurrence of flexion deformity. (H, I) Postoperative hip anteroposterior and lateral view show a well-reduced subtrochanteric fracture treated with a single large lag-screw cephalomedullary device.

Fig. 2 (A-C) Initial hip Anteroposterior view, hip joint lateral and pelvis computed tomography images show a spiral subtrochanteric fracture of the femur with a large fragment. (D, E) The fracture was reduced satisfactorily using cable grip and proximal femoral nail antirotation after surgery. (F, G) Fracture healing is evident 1 year after surgery. (H, I) Limited open reduction through a small incision with cable grip was done before nail insertion.

Fig. 1

Fig. 2

The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

Table 1

Katz Activities of Daily Living Index

Independence: 1, Dependence: 0.

Table 2

Koval Score

Table 3

Comparison of Results for Comminution, Reduction Method, Cleveland Index

Nonunion: 2 cases.

Table 1 Katz Activities of Daily Living Index

Independence: 1, Dependence: 0.

Table 2 Koval Score

Table 3 Comparison of Results for Comminution, Reduction Method, Cleveland Index

Nonunion: 2 cases.