Subtrochanteric fractures of the femur. Treatment with locking intramedullary nailing. An experience without C-Arc. The guide-wire stopping method for verify distal locking is described

Abstract

ObjectiveEvaluate the results of treatment of subtrochanteric fracture with interlocked intramedullary nail and describe a technical for accurate and secure verification of distal locking position when we do surgery without arc-C. MethodsA case series where was reviewed the results in 49 patients with subtrochanteric fracture and treated locking intramedullary nailing. The AO and Russell–Taylor Classification were used. The statistic procedure was done with SPSS program. The traumatic hip scale of Sander et al. was used for final evaluation. Technical for doing distal locking is detailed. ResultsThis series evaluated 49 patients: 35 male and 14 female patients. The mean age was 36 years old (range: 18–86 years). Traffic accidents and gunshot wounds were injury forms most frequent. There were not transoperative complications. The surgical time was between 90 and 120min (mean: 108min). The mean follow-up was 24 months (range: 18–36 months). According to Sanders score, it was reported 22 excellent results, 20 good results and 7 regular results. All distal locking procedures were successfully performed. ConclusionAlthough this series consists in a few numbers of patients, we recommend the placement of interlocked intramedullary nail (Closs-MB Bioimpianti® and Orthosintese®) in subtrochanteric fractures. This device allows placement of distal locking through the insertion frame with safety and precision, even in surgery rooms without arc-C. The guide-wire stopping method allows the verification of distal locking in an objective, accurate, safe and reproducible way.