Clinical Results of Complex Subtrochanteric Femoral Fractures with Long Cephalomedullary Hip Nail

Abstract

Purpose: Good results of the cephalomedullary nails have been reported in proximal femoral fractures recently. Based on length of nails and shape of screws fixed in a femoral head for proximal fragment fixation, the proper nail length was in dispute. The purpose of this study was to evaluate the clinical and radiological results of a long cephalomedullary hip nail for the treatment of comminuted subtrochanteric femoral fractures.

Materials and methods: Twenty-one consecutive patients with severe subtrochanteric femoral fractures who had undergone intramedullary fixation using long-PFNA II between March 2010 and March 2013 were followed-up for over 12 months. Their mean age was 64.8 years old (range, 43-85 years). Sixteen of 22 cases were high energy trauma. According to Seinsheimer's classification, 5 cases were type IV and 16 cases were type V. For radiological assessment, time to union, change of neck-shaft angle, sliding length, tip-apex distance (TAD) and leg length discrepancy (LLD) were measured. For clinical evaluation, a modified Koval index was investigated.

Results: Mean operation time was 96 minutes. An average decrease of neck-shaft angle was 4.5°. The average sliding length of the helical blade was 4.2 mm. Average LLD was 3.0 mm, and TAD was 23.0 mm. Mean modified Koval index score at final follow-up was 4.6 points. All the 21 subtrochanteric fractures healed uneventfully on an average of 24.2 weeks (range, 18-30 weeks).

Conclusion: Long cephalomedullary hip nail provides excellent clinical and radiological outcomes in the comminuted subtrochanteric fracture.

Keywords: Femur; Long cephalomedullary hip nail; Subtrochanteric fracture.

Fig. 1. Plain radiographs of comminuted subtrochanteric fracture of a 53-year-old male patient. (A) Preoperative radiograph. (B) Immediate postoperative radiograph. (C) Post-operative 8 months follow-up radiograph.

Fig. 2. Seventy three year old male patient complained lateral aspect pain at the left lateral position. (A) Immediate postoperative radiographs. (B) One year after operation radiograph that shows sliding of helical blade screw. (C) Helical blade screw was removed due to sustained discomforts and pain on the trochanteric region.