PDF
ePub
Citation
Print
Abstract
The subtrochanteric fractures of femur have high rates of delayed union or nonunion due to less-dense cancellous bone, insufficient cortical blood flow and high stress concentration. Anatomical reduction and rigid internal fixation are important in this region; however, an open reduction might damage the biological environment at the fracture site as well as increase the risk of nonunion. We present our experience with nine cases of subtrochanteric femur fractures surgically fixated with intramedullary nailing after percutaneous cerclage wiring through minimal incision.
Figures and Tables
Fig. 1
Surgical technique.
(A) Closed reduction by percutaneous cerclage wiring.
(B) Nail insertion.
Fig. 2
(A) A 32-year-old man's radiographs demonstrating Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association (AO/OTA) type 32-B1 subtrochanteric femur fracture.
(B) Anteroposterior and lateral radiographs of the same patient 5 months postoperatively.
(C) Postoperative functional photograph.
Fig. 3
(A) A 55-year-old man's radiographs demonstrating Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association (AO/OTA) type 32-B1 subtrochanteric femur fracture.
(B) Intraoperative radiograph shows cerclage wiring and clamp assisted reduction.
(C) Radiograph at 6 months after surgery shows solid bony union.
References
1. Afsari A, Liporace F, Lindvall E, Infante A Jr, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg Am. 2009; 91:1913–1918.
2. Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury. 2013; 44:168–174.
3. Chevalley F, Gamba D. Gamma nailing of pertrochanteric and subtrochanteric fractures: clinical results of a series of 63 consecutive cases. J Orthop Trauma. 1997; 11:412–415.
4. Kennedy MT, Mitra A, Hierlihy TG, Harty JA, Reidy D, Dolan M. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years. Injury. 2011; 42:1317–1321.
5. Leunig M, Hertel R, Siebenrock KA, Ballmer FT, Mast JW, Ganz R. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop Relat Res. 2000; (375):7–14.
6. Mehta V, Finn HA. Femoral artery and vein injury after cerclage wiring of the femur: a case report. J Arthroplasty. 2005; 20:811–814.
7. Müller T, Topp T, Kühne CA, Gebhart G, Ruchholtz S, Zettl R. The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop. 2011; 35:1237–1243.
8. Nikolaou VS, Papathanasopoulos A, Giannoudis PV. What's new in the management of proximal femoral fractures? Injury. 2008; 39:1309–1318.
9. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP. Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury. 2007; 38:1286–1293.
10. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC. Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry portal. J Orthop Trauma. 2006; 20:240–246.
11. Wiss DA, Brien WW. Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing. Clin Orthop Relat Res. 1992; (283):231–236.
12. Yoon TR, Rowe SM, Song EK, Seol JY, Shin SG. Treatment of subtrochanteric fracture - comparison of treatment efficacy according to internal fixation device -. J Korean Soc Fract. 2001; 14:189–199.
XML Download