Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation

Gu-Hee Jung

doi:10.12671/jkfs.2011.24.3.223

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Jung: Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(3): 223-229.

Published online: 15 July 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.3.223

Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation

Gu-Hee Jung, M.D.

Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea.

Address reprint requests to: Gu-Hee Jung, M.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 34, Amnam-dong, Seo-gu, Busan 602-030, Korea. Tel: 82-51-990-6785, Fax: 82-51-243-0181, jyujin2001@kosin.ac.kr

Received 3 September 2010 Revised 7 December 2010 Accepted 11 April 2011

(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

To evaluate the efficiency of provisional K-wire fixation in intertrochanteric fractures treated with proximal femoral nail (PFN).

Materials and Methods

Twenty seven patients (by AO/OTA classification, A1 8 cases, A2 19 cases) were treated with PFN with percutaneous reduction and provisional K-wire fixation, and followed a mean 24.5 months. The adequacy of fracture reduction was assessed by Fogagnolo's classification and reestablishment of bone-to-bone contact with the medial anatomy. Functional results were evaluated by postoperative complications, Jensen's method and Harris hip score (HHS).

Results

In all cases, the bone-to-bone contact with the medial anatomy was reestablished by percutaneous reduction and examination of Fogagnolo's classification showed a good reduction. The technical complications and error of starting point were not occurred. The mean HHS was 76.5 and means Jensen's grade was 2.1 grades. Complications included excessive sliding in 1 case and early cutting-out of screw in 1 case.

Conclusion

The provisional K-wire fixation in trochanteric fracture treated with PFN had an advantage in preventing technical complications because it facilitates a nail insertion in ideal position.

Keywords: Femur, Trochanteric fracture, Provisional K-wire fixation, Proximal femoral nail

Figures and Tables

Fig. 1

Percutaneous reduction technique.

(A~C) The medial anatomy was reduced directly by pushing the proximal fragment using the ball-spike instrument.

(D, E) A fracture of greater trochanter was percutaneously reduced and fixed with K-wire.

(F) The intertrochatneric fracture was provisionally fixed with K-wires.

(G~I) The overlap of the head and neck fragment from the shaft was disimpacted using the Langenbeck elevator.

Fig. 2

Surgical Technique.

(A~C) After percutaneous reduction and provisional K-wires fixation, the reamer for lag screw was firstly inserted to make the entry portal and then, reamer for nail.

(D, E) the K-wire was removed during nail insertion.

(F, G) After nail insertion, the reduction was lost and provisionally fixed with K-wire for reduction.

(H) The lag screw was inserted in deep and central area of femoral head.

Fig. 3

Clinical photo revealed the nail insertion through minimal incision after provisional K-wire fixation and percutaneous reduction.

Fig. 4

(A) Initial radiographs showed the transverse intertrochanteric fracture.

(B, C) The postoperative radiographs showed a good reduction and accurate point of nail insertion but the lag screw was not located in deep area of the femoral head (TAD=37.2 mm).

(D) After 7 days, the lag screw was penetrated the femoral head and the fracture was collapsed.

(E, F) the lag screw was revised.

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