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HOME > J Musculoskelet Trauma > Volume 34(2); 2021 > Article
Original Article 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
Journal of Musculoskeletal Trauma 2021;34(2):64-70.
DOI: https://doi.org/10.12671/jkfs.2021.34.2.64
Published online: April 30, 2021
Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea

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Abstract

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.


J Korean Fract Soc. 2021 Apr;34(2):64-70. Korean.
Published online Apr 23, 2021.
https://doi.org/10.12671/jkfs.2021.34.2.64
Copyright © 2021 The Korean Fracture Society. All rights reserved.
Original Article

Comparison of Reductions of Left and Right Proximal Portions of Intertrochanteric Fractures Treated by Intramedullary Nailing

Hyun Cheol Oh, M.D., Joong Won Ha, M.D., Yung Park, M.D., Sang Hoon Park, M.D. and Han Kook Yoon, M.D.
    • Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • Correspondence to: Han Kook Yoon, M.D. Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea. Tel: +82-31-900-0540, Fax: +82-31-900-0343, Email: hangugy@nhimc.or.kr
Received December 31, 2020; Revised January 18, 2021; Accepted March 19, 2021.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 diagnosis 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.

Keywords
Femur, Intertrochanteric fractures, Lag screw

Figures

Fig. 1
Artificial femoral bone of the right side, when a lag screw is inserted, it generates a clockwise rotational force and the proximal fragment is rotated internally.

Fig. 2
Artificial femoral bone of the left side, when a lag screw is inserted, it generates a clockwise rotational force and the proximal fragment is rotated externally.

Fig. 3
The proximal fragment was located in the intramedullary area (A) and the extramedullary area (B). The proximal fragment rotated internally (C) and externally (D).

Fig. 4
An 85-year-old female patient with left side intertrochanteric fracture underwent surgery using a proximal femur nail. (A) Preoperative anteroposterior and axial radiographs showing a displaced intertrochanteric fracture. (B) Initial three-dimensional computed tomography (CT) revealed an AO/OTA 31-A2.3 fracture. (C) Preoperative axial CT of the proximal greater trochanter area showing that the proximal fragment had been displaced slightly posteriorly (arrow). (D) Preoperative axial CT of the lesser trochanter area showing that the proximal fragment had been displaced posteriorly and intramedullary (arrow). (E) Postoperative anteroposterior and axial radiograph showing that the proximal fragment had been displaced medially and anteriorly. (F) Postoperative axial CT of the proximal greater trochanter area showing that proximal fragment had been displaced posteriorly as compared with its preoperative position (arrow). (G) Postoperative axial CT of the lesser trochanter area showing that the proximal fragment had been displaced anteriorly. These observations showed the proximal fragment had rotated externally (arrow).

Tables

Table 1
Patient Demographics

Table 2
Comparison of Results

Notes

Financial support:This work was supported by National Health Insurance Service Ilsan Hospital grant NHIMC2016CR057.

Conflict of interests:None.

References

    1. Oh HC, Yoo JH, Ha JW, Park Y, Park SH, Yoon HK. Effect of postoperative parathyroid hormone administration on osteoporotic intertrochanteric fractures of females. J Korean Orthop Assoc 2020;55:237–243.
    1. Yang KH. Treatment of pertrochanteric fracture. J Korean Fract Soc 2005;18:76–82.
    1. Song HK, Yoon HK, Yang KH. Presence of a nail in the medullary canal; is it enough to prevent femoral neck shortening in trochanteric fracture? Yonsei Med J 2014;55:1400–1405.
    1. Zlowodzki M, Ayeni O, Petrisor BA, Bhandari M. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma 2008;64:163–169.
    1. Kaufer H, Matthews LS, Sonstegard D. Stable fixation of intertrochanteric fractures. J Bone Joint Surg Am 1974;56:899–907.
    1. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res 1980;(146):53–61.
    1. Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma 2007;21:485–489.
    1. Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg 2015;135:811–818.
    1. Ito J, Takakubo Y, Sasaki K, Sasaki J, Owashi K, Takagi M. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures. Arch Orthop Trauma Surg 2015;135:651–657.
    1. Kozono N, Ikemura S, Yamashita A, Harada T, Watanabe T, Shirasawa K. Direct reduction may need to be considered to avoid postoperative subtype P in patients with an unstable trochanteric fracture: a retrospective study using a multivariate analysis. Arch Orthop Trauma Surg 2014;134:1649–1654.
    1. Tsukada S, Okumura G, Matsueda M. Postoperative stability on lateral radiographs in the surgical treatment of pertrochanteric hip fractures. Arch Orthop Trauma Surg 2012;132:839–846.
    1. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 1996;10 Suppl 1:v–ix. 1–154.
    1. Cho MR, Lee JH, Kwon JB, Do JS, Chae SB, Choi WK. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg 2018;10:292–298.
    1. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007;21(10 Suppl):S1–S133.
    1. Tawari AA, Kempegowda H, Suk M, Horwitz DS. What makes an intertrochanteric fracture unstable in 2015? Does the lateral wall play a role in the decision matrix? J Orthop Trauma 2015;29 Suppl 4:S4–S9.
    1. Poole KE, Treece GM, Ridgway GR, Mayhew PM, Borggrefe J, Gee AH. Targeted regeneration of bone in the osteoporotic human femur. PLoS One 2011;6:e16190
    1. Rha JD, Kim YH, Yoon SI, Park TS, Lee MH. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop 1993;17:320–324.
    1. Suk SI, Lee CK, Baek GH, et al. In: Orthopaedics. Vol. 1. 7th ed. Seoul: The Korean Orthopaedic Association; 2013. pp. 253-254.
    1. Kim J, Choi K, Yang KH. New approach in the treatment of intertrochanteric fracture using a cephalomedullary nail. J Korean Orthop Assoc 2020;55:193–199.
    1. Poole KE, Mayhew PM, Rose CM, et al. Changing structure of the femoral neck across the adult female lifespan. J Bone Miner Res 2010;25:482–491.
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    Comparison of Reductions of Left and Right Proximal Portions of Intertrochanteric Fractures Treated by Intramedullary Nailing
    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
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