Treatment Of Subtrochanteric Femoral Fractures Research Articles

An Alternative Fixation Option for Subtrochanteric Femur Fractures in Children: Adult Proximal Humerus Plate.

Subtrochanteric femur fractures are unstable injuries due to strong muscle forces on the proximal femur. The ideal fixation device is controversial in the treatment of subtrochanteric femur fractures in children. The aim of this study is to evaluate the clinical and radiological outcomes of subtrochanteric femur fractures in children treated with an adult proximal humerus plate. A total of 9 patients [mean age at surgery, 8.3 years (range: 7 to 12); mean follow-up period, 28.1 months (range: 12 to 56)] who underwent surgery due to a subtrochanteric femur fracture and treated with an adult proximal humerus between January 2017 and December 2021 were retrospectively evaluated. Four of the patients had a pathological fracture associated with a benign bone tumor while 5 patients had a nonpathological fracture. The clinical and radiological outcomes were assessed using the Flynn scoring system at the latest follow-up. Time to union and complications were recorded. All patients demonstrated a solid fusion of the fracture site and were able to bear full weight at the latest follow-up. The mean time to union was 8.2 weeks (range: 6 to 10). Based on the Flynn scoring system at the latest follow-up, seven patients had excellent clinical outcomes and two patients had satisfactory outcomes. Two patients had limb length discrepancy, and one patient had coxa valga and a limb length discrepancy of 16mm. There were no patients with nonunion, infection, implant failure, osteonecrosis of the femoral head, and heterotopic bone formation. This study suggests that the adult proximal humerus plate may be an effective alternative fixation option in the treatment of subtrochanteric femur fractures in children, including pathological fractures. Level IV, Case series.

Clinical and radiological results of using proximal femoral locking compression plate and proximal femoral nail antirotation for subtrochanteric fractures.

The aim of this study was to evaluate the results of treatment of subtrochanteric femoral fracture in the use of proximal femoral locking compression plate (PFLCP) and proximal femoral nail antirotation (PFNA). This retrospective study was performed on patients who referred to Firoozgar Hospital in 2017 with subtrochanteric fracture. During follow-up, control radiographs were obtained from patients and the Harris Hip Score questionnaire was completed. Finally, the data were entered into Spss version 22 and then analyzed. A total of 56 patients were included in the study. Patients were divided into two treatment groups of 28: including groups with locking plate and nailing treatment. The results showed that the treatment was not significantly different in patients with subtrochanteric fractures who were treated with either intramedullary nailing or plate placement. There is no difference between the two groups in any of the parameters. The two groups were similar in terms of fracture classification, and finally no significant difference was found in terms of union findings. This study showed that clinical and imaging findings are not significantly different between the two groups of patients with subtrochanteric fracture who are treated with nailing or plate placement.

Management Of Subtrochanteric Femoral Fractures Using Proximal Femoral Nail

Background: Fractures of the proximal femur are a big challenge in traumatology. Rapid strides in implant and instrumentations in quest of ideal fixation of subtrochanteric femoral fractures have made various options available. Objective: The present study aims to study the role of standard proximal femoral nail (PFN) in the management of these fractures. This study aimed to evaluate the results of treatment of subtrochanteric femoral fractures using PFN. Patients and methods: This prospective study conducted at Orthopedic Department, Zagazig University Hospital, from November 2020 to July 2021. It included 24 patients, complaining of closed subtrochanteric fractures treated with PFN (Gamma intramedullary nail). The age ranged from 23 to 87 years (with mean54.21 years), 13 of them were males and 11 females. Road traffic accident (RTA) represented the most common mechanism of injury in 10 patients (41.7%) while fall down represented (37.5%) in 9 patients, and fall from height in 5 patients (20.8%). Results: there was statistically significant difference in HHS among patients with different age groups, mechanism of injury and presence of diabetes mellitus (DM) as associated condition. Statistically there was significant correlation between type of reduction and diabetes mellitus with Harris hip score. Conclusion: This study concluded that the Gamma nail is an excellent choice in treatment of subtrochanteric fractures as it has many advantages as allowing for early functional exercise and full weight-bearing of the affected limb, shortening the duration of operation, high rotation stability, small wounds and minimizing blood loss along with risk of infection

657 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Treatment of Subtrochanteric Femoral Fractures

Abstract Introduction A subtrochanteric femoral fracture occurs in the 5cm of bone distal to the lesser trochanter. This study aims to compare peri-operative outcomes of patients with such fractures treated with either an IMN or a dynamic hip screw (DHS). Method We retrospectively reviewed subtrochanteric fractures presenting to our institution between October 2014 -May 2019, classifying them into two treatment groups: IMN and DHS. These groups were compared using outcomes including surgical time, blood loss, radiation dose area product (DAP), stay length, re-operation rate and mortality. Results During the study period, 86 patients presented with a subtrochanteric fracture, 74 (86%) receiving an IMN and 12 (14%) receiving a DHS. The DHS group showed a significantly lower blood loss (776.19 ml) and DAP (150.30 mGy.cm2) compared to the IMN group (1028.74 ml and 288.86 mGy.cm2 respectively). All other outcome measures failed to reach statistical significance. Conclusions Although National Institute for Health and Care Excellence guidelines recommend treating all subtrochanteric fractures with an IMN; the outcomes assessed did not show use of an IMN to be superior. This, along with the reduced financial cost associated with a DHS; may support the use of DHS over IMN for certain subtrochanteric fractures.

Comparison of third generation long Gamma nail and femur intramedullary nail for the treatment of femoral subtrochanteric fractures

Background/Aim: Internal fixation is the current gold standard procedure in treatment of subtrochanteric femur fractures. One of the most common causes of morbidity after subtrochanteric femoral fracture treatment is mechanical complications, such as implant failure. The aim of this study is to share our experience and compare the radiological and functional results of two different fixation implants in patients with subtrochanteric fractures. Methods: A cohort of 57 patients with a subtrochanteric fracture operated using a third generation Gamma nail (G3LN) or an anterograde intramedullary nail (AIMN) were prospectively followed up. Twenty-eight underwent fracture fixation with the Gamma nail while the other twenty-nine were operated using a conventional AIMN. All patients were followed up until union or, in case of a revision, healing and recovery. Their radiological findings were retrospectively analyzed, and the functional results were assessed using a Harris Hip Score. Results: Data regarding demographic properties such as sex, trauma mechanism and smoking were similar for the subgroups (P 0.05 for each). Compared to the AIMN group, whose reduction was mostly acceptable (48.28%), the majority of G3LN patients (57.14%) had an anatomical reduction on early follow up. Most fractures, regardless of the implant used, needed an open reduction. Both implants showed similar union time and had similar final HHS scores. None of the complication rates reached statistical significance between the two groups (P>0.05 for each). Conclusion: Both third-generation Gamma Nail implant and anterograde intramedullary nailing are viable means of fixation for subtrochanteric hip fractures. They lead to similar and few complications while providing a rigid and secure fixation. These findings lead us to believe that good reduction and adherence to the principles of internal fixation rather than implants used are the key to success in the treatment of subtrochanteric fractures.

Reliability and Usefulness of Radiographic Union Score (RUS) for Fracture Healing Assessment in Subtrochanteric Femoral Fractures

Background: The fracture healing assessment in subtrochanteric femoral fracture (SFF) is essential due to a high rate of implant failure and non-union. It requires an effective diagnostic tool for determining fracture union status. However, significant disagreement exists among clinicians for SFF union diagnosis, and no standardized method is available. Previous studies showed that radiographic union score (RUS) is reliable and highly correlated with fracture healing status. Objective: To evaluate the reliability and diagnostic accuracy of the RUS method for assessing the fracture healing status in the treatment of SFFs. Materials and Methods: The present study was a retrospective review study conducted on 44 SFFs. A panel of seven reviewers, which included five orthopedic surgeons and two musculoskeletal radiologists, assessed the radiographic healing of SFF based on both the RUS method and the physician impression method. The interobserver and intraobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Cohen’s kappa coefficient. The correlation and diagnostic accuracy between RUS and the clinical union were also evaluated. Results: The RUS method resulted in higher intraobserver and interobserver agreement compared to the physician impression method. Inter-rater agreements of the RUS method and physician impression method were moderate (ICC=0.60) and minimal (kappa=0.37), respectively. The RUS method had a higher correlation with clinical union outcome compared to the physician impression method in SFFs (AUC 0.908 versus 0.640). A RUS of 7 or more at 12 weeks had 88% sensitivity and 63% specificity for predicting clinical union outcome. Conclusion: The application of the RUS method is reliable for determining the fracture healing status in SFFs and has better correlation with clinical union than the physician impression method. The RUS method may also be useful for predicting clinical union in SFFs. These results support the use of the radiographic scoring system for fracture healing assessment in SFFs. Keywords: Hip fracture, Subtrochanteric fracture, Fracture healing assessment, Radiographic union, Clinical union, Physician impression

Natural reduction at prone position in treatment of femoral subtrochanteric fractures with intramedullary nailing

Objective To evaluate natural reduction at prone position in the treatment of femoral subtrochanteric fractures with intramedullary nailing. Methods The clinical data of 7 patients with subtrochanteric fracture were retrospectively analyzed who had been treated at Orthopaedic Department, Beijing Tsinghua Changgung Hospital from August 2016 to April 2018. They were 4 males and 3 females, aged from 31 to 87 years (average, 55.6 years). Their fractures happened on the left side in 3 patients and on the right side in 4. By the Seinsheimer classification, there were 3 cases of type Ⅱ, 2 cases of type Ⅲ and 2 cases of type Ⅴ. The time from injury to surgery ranged from 9 to 44 hours, averaging 26 hours. All patients were treated by intramedullary nailing after natural reduction at prone position. Their preoperative preparation time, time required for reduction, total operation time, fluoroscopic frequency for guide pin insertion, fluoroscopic frequency for reduction, reduction quality, complications and curative effect were recorded. Results Closed reduction and intramedullary nail fixation were completed uneventfully in all the 7 cases. Their preoperative preparation time averaged 29.4 min (from 21 to 42 min), reduction time 6.3 min (from 3 to 10 min), and total operation time 157 min (from 82 to 275 min). Their fluoroscopic frequency averaged 37 times (from 14 to 96 times) for guide pin insertion and 23 times (from 10 to 49 times) for reduction, totaling 244 times (from 121 to 360 times). According to the modified Baumgaetner criteria, the fracture reduction was evaluated as excellent in 6 cases and as fair in one. The 7 patients were followed up for 12 to 34 months (mean, 20.1 months). A drill broke at the interlocking nail hole during operation in one patient, deep venous thrombosis occurred at a lower extremity in another during hospitalization, and fracture nonunion was observed after operation in another, but no complications related to the prone position were observed. The curative effect evaluated by Harris hip score at the last follow-up was excellent in 4 cases, as good in 2 cases and as fair in one. Conclusion In the treatment of femoral subtrochanteric fractures with intramedullary nailing, the prone position benefits natural reduction and maintenance of reduction and allows convenient fluoroscopy and nail placement during operation, especially for obese patients. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Reduction; Prone position

Limited open reduction and intramedullary fixation for the treatment of refractory femoral subtrochanteric fractures

To explore the surgical technique and clinical effect of limited open reduction and intramedullary fixation assisted with orthopedic traction bed for the treatment of femoral subtrochanteric fractures. From July 2015 to October 2017, 12 patients with femoral subtrochanteric fractures were treated including 9 males and 3 females with an average age of 44 years old ranging from 33 to 67 years old. Among them, 10 cases were on the left trochanter and 2 on the right, and there were 8 cases of highly fall injury and 4 cases of traffic accident injury. All patients received operation at 2 to 5 days after injury. According to the Seinsheimer classification, 8 cases were type IIIA, 2 were type IIIB and 2 were type IV, and all cases were closed injury. The patients were placed on the orthopedic traction bed for trial closed reduction to maintain proper traction before operation. Under C-arm X-ray fluoroscopy, it was advisable to take the fracture end of the main bone block without obvious shortening and shifting. Then limited incision and lengthened InterTan intramedullary nailing were performed, and the Sanders traumatic hip score was used to evaluate the postoperative efficacy. All 12 patients were followed up from 6 to 24 months with an average of 12 months. All cases were received bone healing at 3 to 6 months with an average time of 4 months. According to the Sanders grades, the results were excellent in 9 cases, good in 2 cases and medium in 1 case. Infection, breakage of internal fixation loosening and adverse complications such as malunion were not appeared in all the cases. Limited open reduction assisted with traction bed can be effective to solve the problem of the intraoperative reduction in the complex subtrochanteric fractures, which could save operation time and decrease bleeding. Combined with intramedullary fixation, this method could acquire good counterpoint and stability for the fracture end, and provide a method for the treatment of refractory subtrochanteric fractures.

Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures

To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures. From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect. Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss(intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group(P<0.05). There was no significant in operative time, hospital stays and complications between two groups(P>0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks(P<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28) and PFLP group (76.49±12.28)(P<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy. Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress.

Technical note and surgical outcomes of percutaneous cable fixation in subtrochanteric fracture: A review of 51 consecutive cases over 4 years in two institutions

BackgroundThe main purpose of this study is to introduce our surgical technique and report surgical outcomes for percutaneous cable fixation in the treatment of subtrochanteric femoral fractures. MethodsBetween May 2013 and April 2017, 51 patients with subtrochanteric femoral fractures treated with closed intramedullary nailing and percutaneous cable fixation were enrolled in this study. Postoperative angulation, union rate, time from injury to union, and femoral shortening were also evaluated to assess radiologic outcomes. Clinical outcomes, including range of hip flexion, walking ability, and Harris hip score at the last follow-up were evaluated. ResultsAverage coronal and sagittal angulation after surgery were 0.9 (range 0–5) and 0.3 (range 0–5), respectively. There was no postoperative angulation of more than 5°. Average shortening of the femur at 1-year follow-up was 2.7 mm (range 0–15). Bone union was achieved in 50 patients (98.0%) and average time to union was 18.6 weeks (range 12–48). Hip flexion, walking ability and Harris hip score at the last follow up were 115.6° (90–120), 7.9 (5–9), and 88.3 (65–100), respectively. ConclusionPercutaneous cerclage cable fixation can provide a greater likelihood of achieving anatomical reduction and increased stability of fracture, while preserving biology around the fracture site. Thus, percutaneous cerclage cable fixation can be an effective surgical technique for the treatment of complex subtrochanteric fractures.

INTRAMEDULLARY NAILING VERSUS FIXED ANGLED BLADE PLATING FOR TREATMENT OF SUBTROCHANTERIC FEMORAL FRACTURE

Background: The subtrochanteric fractures represent 7-44% of the fractures of proximal femur caused by low energy trauma in elderly patients or high energy trauma in younger age group. Different surgical options used to treat and fix this fractures that could be Intramedullary devices like intramedullary nail or extramedullary devices like fixed angle blade plate. Objective: Comparing the result of close reduction and internal fixation with intramedullary nail to the open reduction and internal fixation with 95-angled blade plate for treatment of subtrochanteric fractures. Methods: Prospective multicenter study was done in Al-Imamein Al-kadhimein Medical City and Al-Wasity Teaching Hospital for thirty patients with close and open (Gustilo type-1) subtrochanteric femoral fractures between December-2014 and September-2016. Eighteen patients (8 closed + 10 open fractures) treated with Intramedullary nail (IMN) were compared to twelve patients (9 closed + 3 open fractures) treated with open reduction and 95-angled blade plate fixation (BP). Results: There were significant statistical differences between the two groups. The IMN group show better outcome regarding the mean union rate time (IMN were 16 weeks while in the BP were 22 weeks). Mean hospitalization stay (IMN were 82 hours while in BP were 110 hours) and rate of infection (IMN 0% while in BP were 16%), but no statistical difference regarding the mean operation time (IMN were 1.59 hour while in BP were 1.43 hour) and functional outcome (HHS in IMN were 82 while in BP were 79). Conclusion: Closed reduction and internal fixation with Intramedullary Nail is preferable (for Close and Open Gustilo’s type-1 Subtrochanteric fractures) when compared to the open reduction and Internal Fixation with 95-angled Blade Plate. Keywords:Subtrochanteric femur fractures, closed reduction intramedullary nail fixation, open reduction internal fixation, fixed angle blade plate. Citation: Joda AI, Aldookhi AA, Abd Ali AS. Intramedullary nailing versus fixed angled blade plating for treatment of subtrochanteric femoral fracture. Iraqi JMS. 2018; 16(2): 125-132. doi: 10.22578/IJMS.16.2.3

Treatment of Seinsheimer type III subtrochanteric femoral fractures with prolonged Gamma3 nails and titanium wire fixation in the aged patients

Objective To investigate the treatment of subtrochanteric femoral fractures of Seinsheimer type Ⅲ with prolonged Gamma3 nails and titanium wire fixation in the aged patients. Methods From October 2014 to December 2015, 23 old patients with subtrochanteric femoral fracture were treated with prolonged Gamma3 nails and titanium wire fixation. They were 7 men and 16 women, aged from 62 to 78 years (69.3 years on average). By Seinsheimer classification, 14 cases were type ⅢA and 9 type ⅢB. The time from injury to surgery averaged 3.4 days (from 2 to 6 days). Their operation time, intraoperative bleeding, hospital stay, fracture union time and hip function at the final follow-up were documented. Results Their operation time averaged 1.3 hours (from 1.0 to 1.6 hours), intraoperative bleeding 161 mL (from 115 to 215 mL), and hospital stay 10.7 days (from 9 to 12 days). They obtained follow-ups from 5 to 12 months (9.3 months on average). All the fractures achieved bony union after an average of 15.4 weeks (from 12 to 20 weeks). The function of the affected hip assessed at the final follow-up according to the Harris scoring was excellent in 15 cases, good in 5 and fair in 3, resulting in an excellent to good rate of 87.0%. Their follow-ups revealed no deep venous thrombosis of lower limb, fat embolism, coxa vara, refracture, cut-in of the femoral head by the lag screw, or implant breakage. Conclusions In the treatment of senile subtrochanteric femoral fractures of Seinsheimer type Ⅲ, prolonged Gamma3 nails and titanium wire fixation exhibits advantages of limited operative trauma, rigid fixation, a high rate of union and limited complications. Additionally, this treatment can increase the accuracy of inserting distal locking nails, shorten operation time and improve functional recovery. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Titanium wire

Subtrochanteric fractures treated by cerclage cables and long cephalomedullary nails with minimally invasive technique

Objective To explore the surgical methods and evaluate the postoperative outcomes after cerclage cables and long cephalomedullary nails fixation with minimally invasive technique for the treatment of subtrochanteric femoral fractures. Methods From January 2013 to February 2016, 21 patients with subtrochanteric femoral fractures surgically treated were retrospectively analyzed. There were 14 males and 7 females with an average age of 43.5 years old (ranged from 24 to 71 years old). 11 patients suffered by traffic accidents, 8 patients fell down from heights and 2 patients injured by collapses of heavy objectives. Subtrochanteric fractures were classified by Seinsheimer classification with 2 cases of type ⅡB, 5 cases of type ⅡC, 7 cases of ⅢA, 2 cases of ⅢB, 1 case of Ⅳ and 4 cases of Ⅴ. CT scans of bilateral femurs were performed to measure the length, canal diameter and anterior ache before the operation. All the fractures were treated by cerclage cables and long cephalomedullary nails with minimal invasive technique. 7 cases were fixed by one cable and 14 cases by two or more cables. Results All the patients were followed up with an average of 22.5 months (ranged from 12 to 36 months). The healing time of 20 patients was 3-6 months, with an average time of 4.1 months, except 1 was union by re-operation and the healing time was 13 months after initial operation. According to Harris function evaluation, the average score was 85.4 (ranged from 68 to 97). The clinical outcomes were rated with excellent in 13 cases, good in 6 cases, fair in 1 case and poor in 1 case. The excellent and good rate was 90.5%. Complications included 1 case of screw cut-out and 1 case of nonunion. Conclusion For the treatment of subtrochanteric fractures with spiral, oblique pattern or a big butterfly fragment, satisfactory outcome could be achieved by fixation of cerclage cables and long cephalomedullary nails. The key to healing is to protect the blood supply of the fracture fragments with minimally invasive technique. Key words: Surgical procedures, minimally invasive; Fracture fixation, intramedullary; Hip fractures

Comparison of intramedullary nailing combined with minimally invasive cerclage versus simple in-tramedullary nailing for femoral long oblique subtrochanteric fractures

Objective To compare intramedullary nailing assisted by minimally invasive cerclage with simple intramedullary nailing in the treatment of femoral long oblique subtrochanteric fractures. Methods From April 2010 to September 2015, our department treated 39 patients with femoral long oblique subtrochanteric fracture. Of them, 16 were treated by cephalomedullary nailing combined with minimally invasive cerclage (observation group of 11 males and 5 females with an average age of 42.8±13.2 years) and 23 by simple cephalomedullary nailing (control group of 17 males and 6 females with an average age of 46.2±10.1 years). Their operation time, intraoperative blood loss, radiologic results (union time and alignment) and functional results [Visual Analog Scale (VAS) and Harris hip score] were compared between the 2 groups. Results The 39 patients were followed up from 12 to 30 months (average, 15 months). For the observation group, the varus angle (2.2°±1.4°) was significantly smaller than for the control group(4.1°±2.2°), the VAS scores at 1 and 3 months postoperatively (3.43±1.54, 1.13±1.20) were significantly lower than for the control group (5.61±1.41, 3.34±1.82), and the clinical union ratio at 3 months postoperatively(87.5%, 14/16) signifi-cantly higher than for the control group (47.8%, 11/23) (P 0.05). Conclusions Cephalomedullary nailing is effective for the treatment of femoral long oblique subtrochanteric fractures no matter it is assisted by minimally invasive cerclage or not. However, since minimally in-vasive cerclage has the advantage of improving reduction and mechanical stability, combination of minimally invasive cerclage and cephalomedullary nailing may be more advantageous in early pain-relieving and functional recovery. Key words: Femoral fractures; Fractures, comminuted; Fracture fixation, intramedullary; Bone nails; Surgery, minimally invasive

Variable angle locking plate for treatment of the pediatric subtrochanteric femoral fractures

Objective To explore the clinical effects of variable angle locking plate (VLP) in the treatment of pediatric subtrochanteric femoral fractures. Methods Between January 2012 and November 2014, 9 pre-school children were treated at our department for subtrochanteric femoral fractures. They were 6 boys and 3 girls, with an average age of 4.8 years (from 4 to 6 years). By the Seinsheimer classification, 5 cases were of type ⅡB and 2 of type ⅡC and 2 of type ⅢA. The intervals between injury and surgery averaged 3 days (from 2 to 5 days). All of them were treated with open reduction and VLP internal fixation. Results All the wounds healed well without any infection. All the stitches were removed within 12 days. They were followed up for 8 to 26 months (average, 16 months). All the fractures united within 3 months after operation. Follow-ups revealed no plate or screw loosening, or refracture at the same site. According to the Beaty imaging criteria, the early outcomes were all satisfactory. At the final follow-ups, all the children gained normal gait after full-weight rehabilitation. The affected and normal hips are nearly identical in range of motion and muscle strength. All the children recovered their pre-injury status. By the Sanders scoring for function of the affected hip, 7 cases were rated as excellent and 2 as good. Conclusion VLP can be an effective option for treatment of subtrochanteric femoral fractures in preschool children patients. Key words: Femoral fractures; Fracture fixation, internal; Bone plates; Children

Subtrochanteric femur fracture treated by intramedullary fixation

PurposeTo discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures. MethodsFrom February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37–72 years (mean 53.5 years). According to Seinsheimer classification, there were 2 cases of type I, 7 type II, 15 type III, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type III fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system. ResultsPatients were followed up for 6–12 months. All fractures were healed except one patient with delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%. ConclusionIntramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients' prognosis.

Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center

ObjectiveThe treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population. MethodsThirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment. ResultsThe mean age of patients was 37.53 years. Most were males between 21-40 years old. The dominant mode of injury was traffic accidents (66%). Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B). Average blood loss was 100ml in group A and 200ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B. ConclusionIntramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.

Nailing or plating for subtrochanteric femoral fractures: a non-randomized comparative study

The aim of the present study was to compare the outcomes of reverse less invasive stabilization system for distal femur (LISS-DF) plates and proximal femoral nail antirotation (PFNA) in the treatment of patients with subtrochanteric fracture. Thirty-one patients with 32 fractures were included in this study. The PFNA group consisted of 16 patients, and the reverse LISS-DF plate group consisted of 15 patients. Intraoperative data such as surgical time (min), amount of blood transfusion (units and erythrocyte suspensions) and radiation time (seconds) were noted. Time elapsed until fracture consolidation (weeks), time until full weight bearing (weeks), mean Harris hip score and length of stay (LOS) at hospital (days) were recorded postoperatively. The reverse LISS-DF group had a significantly longer elapsed time until fracture consolidation (p < 0.05). The mean radiation time was significantly longer (p < 0.05), and the Harris hip scores at last control were significantly higher (p < 0.05) compared with the PFNA group. No significant differences were determined in terms of complications and re-operation rates. This study demonstrated that in the reverse LISS-DF-treated group, the mean time for bone union was longer and weight bearing was delayed. Considering the surgical technique, minimal surgical approach, reduced amount of blood transfusion and superior functional results following surgery, we concluded that the PFNA system offers advantages over reverse LISS-DF plating in the treatment of subtrochanteric femur fractures.

Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis.

BackgroundIntramedullary and extramedullary fixation methods are used in the management of subtrochanteric femur fractures. However, whether intramedullary or extramedullary fixation is the primary treatment for subtrochanteric femur fractures in adults remains debatable.Level of evidenceMeta-analyses of prospective studies, level I.Materials and methodsThe Cochrane library, Embase, Google Scholar, and PubMed databases were searched separately for all relevant studies published before January 1, 2015. No language restriction was applied. Prospective randomized controlled trials that compared intramedullary or extramedullary internal fixation to repair subtrochanteric femur fractures in adults were included. We determined intraoperative data, postoperative complications, fracture fixation complications, wound infection, hospital stay days, and final outcome measures to assess the relative effects of different internal fixation methods for the treatment of subtrochanteric femur fractures in adults.ResultsSix studies were included in our meta-analysis. The relative risks (RRs) of revision rate was 83% lower (RR, 0.17, 95% confidence interval [CI], 0.05 to 0.60; P=0.006), fixation failure rate was 64% lower (RR, 0.36, 95% CI, 0.12 to 1.08; P=0.07), non-union rate was 77% lower (RR, 0.23, 95% CI, 0.07 to 0.81; P=0.02) in the intramedullary group compared with the extramedullary group. No significant differences were found between the intramedullary group and extramedullary group for intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures.ConclusionIn conclusion, our meta-analysis suggests that there was no significant difference in intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures between intramedullary and extramedullary internal fixation. However, a significant decrease occurred in the rate of fracture fixation complications for patients treated with intramedullary internal fixation, especially in elderly patients. Some differences were not significant, but the treatment of elderly subtrochanteric femur fractures using intramedullary internal fixation is recommended.

Reducing subtrochanteric femur fractures: tips and tricks, do's and don'ts.

Treatment of subtrochanteric fracture remains a challenge, but evolution of strategy has allowed for reliable results with low complications. Although several fixation options exist, reamed, antegrade intramedullary nailing (IMN) has evolved as the standard of care. Cognizant effort to achieve anatomic reduction before IMN passage allows for desired outcomes. Several reduction techniques can be used to overcome the deforming forces present in the proximal femur to allow for proper IMN placement. The purpose of this article is to review the tips, tricks, and pitfalls to avoid in the treatment of subtrochanteric femur fractures with IMN.