Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail

Phil Hyun Chung; Suk Kang; Jong Pil Kim; Young Sung Kim; Ho Min Lee; Dae Jung Huh

doi:10.5371/hp.2013.25.1.51

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Chung, Kang, Kim, Kim, Lee, and Huh: Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail

Original Article

Hip & Pelvis

Hip & Pelvis 2013; 25(1): 51-56.

Published online: 31 March 2013

DOI: https://doi.org/10.5371/hp.2013.25.1.51

Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail

Phil Hyun Chung, MD, PhD, Suk Kang, MD, PhD, Jong Pil Kim, MD, Young Sung Kim, MD, Ho Min Lee, MD, Dae Jung Huh, MD

Department of Orthopaedic Surgery, Dongguk University Gyeongju Hospital, College of Medicine, Dongguk University, Gyeongju, Korea.

Address reprint request to Suk Kang, MD, PhD. Department of Orthopaedic Surgery, Dongguk University, Gyeongju Hospital, 87 Dongdae-ro, Gyeongju 780-350, Korea. TEL: +82-54-770-8224, FAX: +82-54-770-8378, cbg1196@hanmail.net

Received 15 October 2012 Revised 14 February 2013 Accepted 15 February 2013

(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 analyze the clinical and radiographic results of treatment of unstable pertrochanteric hip fractures in which the fracture line is extended distally or the width of the canal is wide using a long intramedullary nail.

Materials and Methods

From January 2005 to January 2010, we conducted an analysis of 20 cases of unstable pertrochanteric hip fractures (over AO/OTA 31 A2.2) treated using a long intramedullary nailing and followed up for more than 12 months. Using postoperative and last follow-up radiographs, we measured TAD, Cleveland index, neck-shaft angle, sliding length of the lag screw, and union time. Clinically, we measured the operation time, the amount of transfusion, and Parker and Palmer's mobility score.

Results

The mean bony union time was 16.4 weeks(10-21 weeks). The mean sliding length of the lag screw was 4.3 mm(1-10 mm) and the mean varus angulation after surgery was 5.1°(3-8°). The mean operative time was 118 min(60-140 min), and the mean transfusion amount was 2.0 pint(0-4 pint). According to Parker and Palmer's mobility score, mean preoperative score was 7.5 points and mean postoperative score at last follow-up was 6.9 points.

Conclusion

In treatment of unstable pertrochanteric hip fractures, when the fracture line was extended to below the lesser trochanteric level or the medullary canal width was wide, use of a long intramedullary nail showed excellent clinical and radiologic results and can be regarded as a good treatment option.

Keywords: Femur, Unstable pertrochanteric fracture, Long intramedullary nail

Figures and Tables

Fig. 1

(A) Canal diameter at lesser trochanter level. (B) Canal diameter at 2 cm above lesser trochanter. (C) Canal diameter at 7 cm below lesser trochanter. (D) Cortex diameter at isthmus. (E) Canal diameter at isthmus. Cortical index (CI) equals the ratio of the femoral diaphyseal diameter minus the intramedullary canal diameter over the femoral diaphyseal diameter: isthmus CI=(D-E)/D.

Fig. 2

(A) Initial radiograph of 77 years old male show A2.2 pertrochanteric hip fracture. (B) Fracture was fixed with long ITST nail. (C) Radiograph at postoperative 6 months shows complete union.

Table 1

Radiologic Mesurements of Proximal Femur

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