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.
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.
![jkfs-24-223-g001](/upload/SynapseData/ArticleImage/0104jkfs/jkfs-24-223-g001.jpg)
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.
![jkfs-24-223-g002](/upload/SynapseData/ArticleImage/0104jkfs/jkfs-24-223-g002.jpg)
Fig. 3
Clinical photo revealed the nail insertion through minimal incision after provisional K-wire fixation and percutaneous reduction.
![jkfs-24-223-g003](/upload/SynapseData/ArticleImage/0104jkfs/jkfs-24-223-g003.jpg)
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.
![jkfs-24-223-g004](/upload/SynapseData/ArticleImage/0104jkfs/jkfs-24-223-g004.jpg)
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