Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction

Sang Joon Lee; Sang Hong Lee; Sang Soo Park; Hyung Seok Park

doi:10.4055/jkoa.2015.50.1.18

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Lee, Lee, Park, and Park: Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(1): 18-24.

Published online: 28 February 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.1.18

Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction

Sang Joon Lee, M.D., Sang Hong Lee, M.D., Sang Soo Park, M.D., Hyung Seok Park, M.D.

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

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 5 August 2014 Revised 24 September 2014 Accepted 24 October 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

The purpose of the study was to evaluate methods for treatment of femur subtrochanteric fractures using the intramedullary long nail.

Materials and Methods

This retrospective study included 44 patients (44 cases) who were available for follow-up for at least one year. The patients had undergone intramedullary fixation specifically with a long nail for traumatic femur subtrochanteric fractures during the period from June 2005 to May 2012 in Chosun University Hospital. The study compares two groups. For group 1, closed reduction was attempted, and group 2 underwent minimal open reduction. Group 1 included 27 cases, and group 2 included 17 cases. Study parameters included injury mechanism, fracture classification according to the Seinsheimer type, nail design, size of skin incision, alignment, bony union time, malunion or nonunion, and complications.

Results

Bony union times were 19.4 weeks (group 1) versus 21.4 weeks (group 2), but there were no statistical differences between the two groups with respect to gender, injury mechanism, fracture classification, or nail design. However, there were significant differences between the two groups with respect to skin incision, malalignment, and complications. Gender, injury mechanism, fracture classification, nail design, size of skin incision, minimal open reduction or close reduction, did not show a significant relationship with bony union. However, in cases of malalignment, the possibility of malunion increased 1.5 times per 1° increase in malaligment.

Conclusion

In treatment of femur subtrochanteric fracture using intramedullary nail, nonunion rate increases when malalignment occurs. Therefore, anatomical reduction with minimal open reduction is necessary if closed reduction is not satisfactory.

Keywords: femur subtrochanteric fracture, closed reduction, minimal open reduction, intramedullary long nail

Figures and Tables

Figure 1

(A) This x-ray shows a subtrochanteric comminuted femur fracture in a 43-year-old male. (B, C) Postoperative radiographs after application of a Sirus® femoral nail with closed reduction. (D, E) Femur anteroposterior and lateral radiographs taken six months after the operation show delayed union. (F, G) Femur anteroposterior and lateral radiographs taken nine months after the operation show bone union in a varus position. (H, I) Femur anteroposterior and lateral radiographs after implant removal.

Figure 2

(A) This anteroposterior radiograph shows a subtrochanteric femur fracture in a 48-year-old male. (B, C) Postoperative radiographs after application of a Sirus® femoral nail with closed reduction. (D, E) Radiographs taken six months after the operation show nonunion. (F, G) Radiographs taken immediately after the second operation show applied additional plate with autogenous iliac bone graft. (H, I) Bone union was observed at three months after the second operation.

Figure 3

(A) This x-ray of the femur of a 58-year-old man shows a subtrochanteric femur fracture. (B) Minimal open reduction using a bone holder. (C, D) Postoperative femur anteroposterior and lateral radiographs after application of a MDN® femoral nail. (E, F) Femur anteroposterior and lateral radiographs taken six months after the operation show delayed union. (G, H) Femur anteroposterior and lateral radiographs taken eight months after the operation show bone union in good alignment. (I, J) Postoperative radiographs after implant removal.

Table 1

Case Analysis

Values are presented as median (range) or number. Group 1: closed reduction group, Group 2: minimal open reduction group.

Table 2

Odd's Ratio Estimates

Notes

This study was supported by research fund from Chosun University, 2012.

The authors have nothing to disclose.

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