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Abstract
Purpose
The purpose of this study is to analyze the clinical results of fixation using Sirus® nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal.
Materials and Methods
From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus® nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared.
Results
The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment.
Conclusion
Using Sirus® nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.
Figures and Tables
 | Fig. 1For estimation of proper entry portals, we assumed the length of Sirus® nail (s) to circular arc (EF). The radius (r) of the circle was informed by regular manufacturer's information. Finally we estimated the central angle (θ) from the circle and compared with contralateral neck-shaft angle.
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 | Fig. 2Illustration of subdivision by entry points. ①: Lateral entry point, ②: greater trochanter tip entry point, ③: medial entry point.
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 | Fig. 3Preoperative and postoperative antero-posterior view of iatrogenic fracture that occurred in Sirus® nail insertion using lateral entry point.
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Table 2
Comparison of Clinical Results and Complications between Subtrochanteric and Shaft Fracture of the Femur
Values are presented as median (range) or number (%). *Includes screw irritations, heterotrophic ossification, device loosening & breakage and limping gait with pain. †Mal-alignment was defined as more than or equal to 5 degrees of neck-shaft angle compared with contralateral of the subtrochanteric fractures in the coronal plane and 10 degrees of total angular deformity of the femoral shaft fractures in the coronal and sagittal planes, respectively.
Table 3
Comparison of Clinical Results between Entry Portals (n=36)
Values are presented as median (range) or number (%). *Includes screw irritations, heterotophic ossification, device loosening & breakage and limping gait with pain. †Mal-alignment was defined as more than or equal to 5 degrees of neck-shaft angle compared with contralateral of the subtrochanteric fractures in the coronal plane and 10 degrees of total angular deformity of the femoral shaft fractures in the coronal and sagittal planes, respectively.
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