Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture

Hong Moon Sohn; Gwang Chul Lee; Chae Won Lim

doi:10.4055/jkoa.2014.49.4.272

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Sohn, Lee, and Lim: Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(4): 272-277.

Published online: 27 August 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.4.272

Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture

Hong Moon Sohn, M.D., Gwang Chul Lee, M.D., Chae Won Lim, M.D.

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

Correspondence to: Gwang Chul 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, leekci@chosun.ac.kr

Received 2 September 2013 Revised 13 November 2013 Accepted 28 February 2014

(open-access):

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.

Abstract

Purpose

We attempted to determine the cause of iatrogenic fractures and to prevent their occurrence during nailing using lateral entry portal on femur shaft fracture.

Materials and Methods

We conducted a retrospective study of 160 patients who had been treated with nailing using a lateral entry portal for femur shaft fractures. We compared 18 patients (group 1) with iatrogenic fractures on the femur proximal portion with 18 patients (group 2) who had no fracture, and then surveyed and analyzed the characters of the fracture, position of the portal, nail size, and complications.

Results

In distribution of primary femur shaft fractures, there were eight cases of proximal portion, nine cases of mid-portion, and one case of distal portion. In that of iatrogenic fractures, there were nine cases of medial fractures, five cases of lateral fractures, four cases of anterior fractures. In the entry portal of group 1, mean 1.82 mm leaned to the lateral side in antero-posteriorview, mean 5 mm leaned to the anterior side in lateral view. Anterior leaning of the entry portal was statistically significant with iatrogenic fracture.

Conclusion

The more the entry portal leaned to the lateral and anterior side, the greater the frequency of occurrence of iatrogenic fractures. To prevent iatrognic fracture, through preoperative X-ray, we must have a precise understanding and measure anatomical bowing and variance of the femur, and must pay attention to operative procedures during the operation.

Keywords: femoral fractures, intramedullary fracture fixation, iatrogenic fracture

Figures and Tables

Figure 1

(A) Anteroposterior and lateral radiograph of a 27-year-old male injured in a car traffic accident, resulting in a femur midshaft fracture. (B) Postoperative radiographs show iatrogenic fracture of the medial cortex (black arrow) during closed nailing using a lateralized portal on the trochanteric tip (white arrow).

Table 1

Summary of Cases

Values are presented as number, median (range), or mean±standard deviation. BMI, body mass index.

Table 2

Difference between GT Tip and Real Nail Insertion Site

GT, greater trochanter; Lat., lateral; Med., medial; Diff., difference; Ant., anteral; Post., posteral.

Notes

This study was supported by research fund from Chosun University, 2013.

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