Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail?

Ho Hyun Yun; Jung Ro Yoon; Hyo Seong Seo; Jung Jin Yu

doi:10.4055/jkoa.2015.50.1.8

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Yun, Yoon, Seo, and Yu: Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail?

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(1): 8-17.

Published online: 28 February 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.1.8

Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail?

Ho Hyun Yun, M.D., Jung Ro Yoon, M.D., Hyo Seong Seo, M.D., Jung Jin Yu, M.D.

Department of Orthopedic Surgery, VHS Medical Center, Seoul, Korea.

Correspondence to: Ho Hyun Yun, M.D. Department of Orthopaedic Surgery, VHS Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, Korea. TEL: +82-2-2225-4172, FAX: +82-2-2225-1910, 3188yun@naver.com

Received 16 July 2014 Revised 12 August 2014 Accepted 26 September 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 this study is to investigate the constant necessity of distal locking when intertrochanteric fracture was treated with an intramedullary hip nail.

Materials and Methods

From April 2010 to June 2013, 47 stable intertrochanteric fractures (AO/OTA 31-A1) were treated with second generation intramedullary hip nailing. They were followed-up for more than 12 months. In the first group of 18 cases distal locking was used, and in the second group of 29 cases, distal locking was not used. We compared the radiologic and clinical results of the two groups.

Results

Comparison of the two groups of patients showed no difference in terms of radiological and functional results. Postoperative thigh pain developed in eight cases (17%). A statistically difference was observed between isthmic diameter and used nail diameter (Fisher exact test, p=0.01) for postoperative thigh pain. In logistic regression analysis, the difference between isthmic diameter and used nail diameter was the most statistically significant factor in development of postoperative thigh pain (p=0.04, odd ratio=27.75).

Conclusion

Our results suggested that the second generation intramedullary hip nail may be successfully implanted without distal interlocking in 31-A1 intertrochanteric femur fracture when the reduction status was satisfactory and stable fixation of the distal area was estimated by less than 3 mm difference between isthmic diameter and used nail diameter.

Keywords: femur, intertrochanteric fractures, intramedullary hip nail, distal locking

Figures and Tables

Figure 1

(A) Preoperative antero-posterior hip radiograph of a 65-year-old male with a 31A1-2 fracture of his left proximal femur. (B) Postoperative radiograph of the patient four weeks after treatment with the intramedullary hip nail with two distal locking. (C) Postoperative radiograph of the patient 24 months after treatment showing union. (D) Preoperative antero-posterior hip radiograph of an 87-year-old male with a 31A1-2 fracture of his left proximal femur. (E) Postoperative radiograph of the patient four weeks after treatment with the intramedullary hip nail without distal locking. (F) Postoperative radiograph of the patient 12 months after treatment showing union.

Figure 2

(A) Preoperative anteroposterior hip radiograph of a 79-year-old male with a 31A1-2 fracture of his left proximal femur. (B) Postoperative radiograph of the patient four weeks after treatment with the intramedullary hip nail without distal locking. (C) Postoperative radiograph of the patient three months after treatment showing a visible fracture gap with migration of the nail. (D) Postoperative radiograph of the patient six months after treatment showing a persistent fracture gap. (E) Postoperative radiograph of the patient nine months after treatment showing disappearance of the fracture gap. (F) Postoperative radiograph of the patient 12 months after treatment showing union.

Figure 3

(A) Postoperative antero-posterior hip radiograph of a 65-year-old male with a 31A1-1 fracture of his left proximal femur four weeks after treatment with the intramedullary hip nail with two distal locking. (B) Postoperative radiograph of the patient 12 months after treatment showing distal cortical hypertrophy around the locking screw. (C) Postoperative radiograph of the patient four weeks after removal of the nail showing persistent distal cortical hypertrophy. (D) Postoperative radiograph of the patient 24 months after removal of the nail showing decreased distal cortical hypertrophy.

Figure 4

(A) Preoperative antero-posterior hip radiograph of an 85-year-old male with a 31A1-1 fracture of his right proximal femur. (B) Intraoperative radiograph of the patient showing inappropriate position of the distal locking screw. (C) Repeated drilling was performed. (D) Postoperative radiograph of the patient 12 months after treatment showing union.

Table 1

Comparison of Groups of Patients with and without Distal Locking

Values are presented as mean±standard deviation or number only. Group 1: group of patients with distal locking, Group 2: group of patients without distal locking.

Table 2

Thigh Pain with and without Distal Locking

Group 1: group of patients with distal locking, Group 2: group of patients without distal locking.

Table 3

Results of Logistic Regression Analysis for Thigh Pain

Group 1: group of patients with distal locking, Group 2: group of patients without distal locking.

Notes

The authors have nothing to disclose.

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