The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail.

Si Yong Park, Kyu Hyun Yang, Je Huyn Yoo, Han Kook Yoon, Hui Wan Park

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Reverse obliquity intertrochanteric fractures have been recognized as having unique anatomic and mechanical characteristics. Even though some clinical reports regarding intramedullary hip nailing for reverse obliquity intertrochanteric fracture show favorable results, there has been no clinical report of intramedullary hip nailing regarding the clinical significance of the lesser trochanteric fragment which differentiates Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A3.3 from A3.1 and A3.2. METHODS: We retrospectively reviewed the clinical results of 46 cases of reverse obliquity or transverse intertrochanteric fracture treated with intramedullary hip nails. Twenty-five fractures were fixed with proximal femoral nail (PFN), and 21 fractures were fixed with intertrochanteric subtrochanteric nail. RESULTS: Among 40 patients, followed up for more than 6 months, 22 31-A3.3 fractures (84.6%) out of 26 and all 14 A3.1 or A3.2 fractures were healed after the first operation. The complications were four cases of fixation failure and one case of femoral shaft fracture after fall. They occurred in the A3.3 type fracture, which were fixed with the PFN. The mean union time was longer in the A3.3 group (5.98 months, range 3-17 months) compared with that in the A3.1 or A3.2 group (4.65 months, range 3-9 months) (p = 0.048). Two cases of reciprocal migration of two screws (Z-effect) required exchange of the femoral neck screw to a shorter one in the PFN group. The amount of sliding of the femoral neck screw of the PFN (6.8 mm, range 0.3 mm-16.5 mm) was greater than that of the intertrochanteric subtrochanteric nail lag screw (1.89 mm, range: 0.2 mm-4.6 mm) (p = 0.012). Statistical analysis showed that the type of implant PFN, fracture subtype (31-A3.3), and old ages (more than 65 years old) significantly prolonged the union time (p < 0.05). CONCLUSION: The lesser trochanteric fragment and posteromedial defect in 31-A3.3 fracture seems to play an important role in the stability after intramedullary hip nailing. The causes of fixation failure in the PFN group were associated with excessive sliding of femoral neck screw, which was aggravated by toggling motion in the 31-A3.3 fractures.

Original languageEnglish
Pages (from-to)852-857
Number of pages6
JournalThe Journal of trauma
Volume65
Issue number4
Publication statusPublished - 2008 Oct 1
Externally publishedYes

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Hip Fractures
Nails
Hip
Thigh
Intramedullary Fracture Fixation
Femur Neck
Femoral Fractures
Therapeutics
Orthopedics
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail. / Park, Si Yong; Yang, Kyu Hyun; Yoo, Je Huyn; Yoon, Han Kook; Park, Hui Wan.

In: The Journal of trauma, Vol. 65, No. 4, 01.10.2008, p. 852-857.

Research output: Contribution to journalArticle

Park, Si Yong ; Yang, Kyu Hyun ; Yoo, Je Huyn ; Yoon, Han Kook ; Park, Hui Wan. / The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail. In: The Journal of trauma. 2008 ; Vol. 65, No. 4. pp. 852-857.
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abstract = "BACKGROUND: Reverse obliquity intertrochanteric fractures have been recognized as having unique anatomic and mechanical characteristics. Even though some clinical reports regarding intramedullary hip nailing for reverse obliquity intertrochanteric fracture show favorable results, there has been no clinical report of intramedullary hip nailing regarding the clinical significance of the lesser trochanteric fragment which differentiates Arbeitsgemeinschaft f{\"u}r Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A3.3 from A3.1 and A3.2. METHODS: We retrospectively reviewed the clinical results of 46 cases of reverse obliquity or transverse intertrochanteric fracture treated with intramedullary hip nails. Twenty-five fractures were fixed with proximal femoral nail (PFN), and 21 fractures were fixed with intertrochanteric subtrochanteric nail. RESULTS: Among 40 patients, followed up for more than 6 months, 22 31-A3.3 fractures (84.6{\%}) out of 26 and all 14 A3.1 or A3.2 fractures were healed after the first operation. The complications were four cases of fixation failure and one case of femoral shaft fracture after fall. They occurred in the A3.3 type fracture, which were fixed with the PFN. The mean union time was longer in the A3.3 group (5.98 months, range 3-17 months) compared with that in the A3.1 or A3.2 group (4.65 months, range 3-9 months) (p = 0.048). Two cases of reciprocal migration of two screws (Z-effect) required exchange of the femoral neck screw to a shorter one in the PFN group. The amount of sliding of the femoral neck screw of the PFN (6.8 mm, range 0.3 mm-16.5 mm) was greater than that of the intertrochanteric subtrochanteric nail lag screw (1.89 mm, range: 0.2 mm-4.6 mm) (p = 0.012). Statistical analysis showed that the type of implant PFN, fracture subtype (31-A3.3), and old ages (more than 65 years old) significantly prolonged the union time (p < 0.05). CONCLUSION: The lesser trochanteric fragment and posteromedial defect in 31-A3.3 fracture seems to play an important role in the stability after intramedullary hip nailing. The causes of fixation failure in the PFN group were associated with excessive sliding of femoral neck screw, which was aggravated by toggling motion in the 31-A3.3 fractures.",
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T1 - The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail.

AU - Park, Si Yong

AU - Yang, Kyu Hyun

AU - Yoo, Je Huyn

AU - Yoon, Han Kook

AU - Park, Hui Wan

PY - 2008/10/1

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N2 - BACKGROUND: Reverse obliquity intertrochanteric fractures have been recognized as having unique anatomic and mechanical characteristics. Even though some clinical reports regarding intramedullary hip nailing for reverse obliquity intertrochanteric fracture show favorable results, there has been no clinical report of intramedullary hip nailing regarding the clinical significance of the lesser trochanteric fragment which differentiates Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A3.3 from A3.1 and A3.2. METHODS: We retrospectively reviewed the clinical results of 46 cases of reverse obliquity or transverse intertrochanteric fracture treated with intramedullary hip nails. Twenty-five fractures were fixed with proximal femoral nail (PFN), and 21 fractures were fixed with intertrochanteric subtrochanteric nail. RESULTS: Among 40 patients, followed up for more than 6 months, 22 31-A3.3 fractures (84.6%) out of 26 and all 14 A3.1 or A3.2 fractures were healed after the first operation. The complications were four cases of fixation failure and one case of femoral shaft fracture after fall. They occurred in the A3.3 type fracture, which were fixed with the PFN. The mean union time was longer in the A3.3 group (5.98 months, range 3-17 months) compared with that in the A3.1 or A3.2 group (4.65 months, range 3-9 months) (p = 0.048). Two cases of reciprocal migration of two screws (Z-effect) required exchange of the femoral neck screw to a shorter one in the PFN group. The amount of sliding of the femoral neck screw of the PFN (6.8 mm, range 0.3 mm-16.5 mm) was greater than that of the intertrochanteric subtrochanteric nail lag screw (1.89 mm, range: 0.2 mm-4.6 mm) (p = 0.012). Statistical analysis showed that the type of implant PFN, fracture subtype (31-A3.3), and old ages (more than 65 years old) significantly prolonged the union time (p < 0.05). CONCLUSION: The lesser trochanteric fragment and posteromedial defect in 31-A3.3 fracture seems to play an important role in the stability after intramedullary hip nailing. The causes of fixation failure in the PFN group were associated with excessive sliding of femoral neck screw, which was aggravated by toggling motion in the 31-A3.3 fractures.

AB - BACKGROUND: Reverse obliquity intertrochanteric fractures have been recognized as having unique anatomic and mechanical characteristics. Even though some clinical reports regarding intramedullary hip nailing for reverse obliquity intertrochanteric fracture show favorable results, there has been no clinical report of intramedullary hip nailing regarding the clinical significance of the lesser trochanteric fragment which differentiates Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A3.3 from A3.1 and A3.2. METHODS: We retrospectively reviewed the clinical results of 46 cases of reverse obliquity or transverse intertrochanteric fracture treated with intramedullary hip nails. Twenty-five fractures were fixed with proximal femoral nail (PFN), and 21 fractures were fixed with intertrochanteric subtrochanteric nail. RESULTS: Among 40 patients, followed up for more than 6 months, 22 31-A3.3 fractures (84.6%) out of 26 and all 14 A3.1 or A3.2 fractures were healed after the first operation. The complications were four cases of fixation failure and one case of femoral shaft fracture after fall. They occurred in the A3.3 type fracture, which were fixed with the PFN. The mean union time was longer in the A3.3 group (5.98 months, range 3-17 months) compared with that in the A3.1 or A3.2 group (4.65 months, range 3-9 months) (p = 0.048). Two cases of reciprocal migration of two screws (Z-effect) required exchange of the femoral neck screw to a shorter one in the PFN group. The amount of sliding of the femoral neck screw of the PFN (6.8 mm, range 0.3 mm-16.5 mm) was greater than that of the intertrochanteric subtrochanteric nail lag screw (1.89 mm, range: 0.2 mm-4.6 mm) (p = 0.012). Statistical analysis showed that the type of implant PFN, fracture subtype (31-A3.3), and old ages (more than 65 years old) significantly prolonged the union time (p < 0.05). CONCLUSION: The lesser trochanteric fragment and posteromedial defect in 31-A3.3 fracture seems to play an important role in the stability after intramedullary hip nailing. The causes of fixation failure in the PFN group were associated with excessive sliding of femoral neck screw, which was aggravated by toggling motion in the 31-A3.3 fractures.

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