Nailing of pertrochanteric fractures – operative technique

Czech version

Authors: J. Skála-Rosenbaum; P. Douša; R. Bartoška
Authors‘ workplace: Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha-Vinohrady přednosta: Prof. MUDr. M. Krbec, CSc.
Published in: Rozhl. Chir., 2013, roč. 92, č. 10, s. 607-614.
Category: Various Specialization

Práce je určena k postgraduálnímu vzdělávání lékařů.

Overview

Nailing of pertrochanteric fractures is indicated when DHS is associated with high rate of complications. Thus in unstable comminuted fractures, mainly with posterolateral defect and instability, with Adam´s arch defect and medial instability and in cases when fracture line extends into the subtrochanteric region. The increase in number of nailed pertrochanteric fractures has both its rational and irrational reasons; irrational, as until now there is no clear evidence, that nailing is a faster, safer and easier procedure with a lower rate of complications compared with DHS, a rational, as a proven increase in number of unstable and comminuted fractures has to be reflected in treatment changes. Thus, with respecting the operative techniques principles, intramedullary nailing provides evident biomechanical advantages with the possibility of full weight-bearing and a very low rate of complications.

Key words:
hip fracture – pertrochanteric fracture – nailing – lag screw – distal locking – operative technique

Sources

1. Müller ME, Nazarian S, Koch P, Schatzker J (eds). The comprehensive classification of fractures of long bones. Berlin, Springer 1990;120–121.

2. Anglen JO, James N. Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: Changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg 2008;90–A:700–709.

3. Forte ML, Virnig BA, Kane RL, Durham S, Bhandari M, et al. Geographic variation in device use for intertrochanteric hip fractures. J Bone Joint Surg 2008;90–A:691–699.

4. Douša P, Bartoníček J, Jehlička D, Skála-Rosenbaum J. Osteosyntéza trochanterických zlomenin proximálním femorálním hřebem (PFN Synthes). Acta Chir Orthop Traumatol Cech 2002; 69:22–30.

5. Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury 2012;43: 706–711.

6. Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, et al. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures? A review. Injury 2012;43:686–693.

7. Kregor J, Obremskey W, Kreder HJ, Swiontkowski MF. Unstable pertrochanteric femoral fractures. J Orthop Trauma 2005;19:63–66.

8. Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, et al. Pertrochanteric fractures: Is there an advantage to an intramedullary nail? J Orthop Trauma 2002;16:386–393.

9. Dujardin FH, Benez C, Polle G, Alain J, Biga N, et al. Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results. J Orthop Trauma 2001;15:401–406.

10. Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop 2006;30:69–78.

11. Steinberg GG, Desai SS, Kornwitz NA, Sullivan TJ The intertrochanteric hip fracture. A retrospective analysis. Orthopedics 1988;11:265–273.

12. Parker MJ Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand 1996;67:329–332.

13. Bartoníček J, Frič V, Skála-Rosenbaum J, Douša P. Avascular necrosis of the femoral head in pertrochanteric fractures: A report of 8 cases and a review of the literature. J Orthop Trauma 2007;21:229–236.

14. Douša P, Čech O, Weissinger M, Džupa V. Trochanterické zlomeniny femuru. Acta Chir Orthop Traumatol Cech 2013;80:15–26.

15. Skála-Rosenbaum J, Bartoníček J, Říha D, Waldauf P, Džupa V. Single-center study of hip fractures in Prague, Czech Republic, 1997–2007. Int Orthop 2011;35:587–593.

16. Sears BR, Ostrum RF, Litsky AS. A mechanical study of gap motion in cadaveric femurs using short and long supracondylar nails. J Orthop Trauma 2004;18:354–360.

17. Hou Z, Bowen TR, Irgit KS, Matzko ME, Andreychik CM, et al. Treatment of pertrochanteric fractures (OTA 31-A1 and A2): Long versus short cephalomedullary nailing. J Orthop Trauma 2013;27:318–324.

18. Curtis R, Goldhahn J, Schwyn R, Regazzoni P, Suhm N. Fixation principles in metaphyseal bone ? a patent based review. Osteoporos Int 2005;16 Suppl 2:S54–64.

19. Skála-Rosenbaum J, Bartoníček J, Bartoška R. Is distal locking with IMHN necessary in every pertrochanteric fracture? Int Orthop 2010;34:1041–1047.

20. Stern R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop 2011;35:1855–1861.

21. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Rel Res 1998;348:87–94.

22. Palmer H, Jacobsen S, Sonne-Holm S, Gebuhr P. Integrity of the lateral wall in intertrochanteric hip fractures: An important predictor for reoperation. J Bone Joint Surg 2007;89–A:470–475.

23. Fensky F, Nuchtern JV, Kolb JP. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures ? A biomechanical cadaver study. Injury 2013;44:802–807.

24. Kyle RF, Gustilo RB, Premer RF. Analysis of sixhundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg 1979;61–A:216–221.

25. Konstantinidis L, Papaioannou C, Hirschmüller A, Pavlidis T, Schroeter S, et al. Intramedullary nailing of trochanteric fractures: central or caudal positioning of the load carrier? A biomechanical comparative study on cadaver bones. Injury 2013;44: 784–790.

26. Kubiak EN, Bong M, Park SS, Kummer F, Egol K, et al. Intramedullary fixation of unstable intertrochanteric hip fractures: one or two lag screws. J Orthop Trauma 2004;18:12–17.

27. Bartoníček J, Heřt J. Základy klinické anatomie pohybového aparátu. Maxdorf, Jessenius 2004.

28. Haidukewych GJ. Intertrochanteric fractures: Ten tips to improve results. J Bone Joint Surg 2009;91–A:712–719.

29. Bartoníček J, Douša P, Krbec M. Komplikace osteosyntézy gama hřebem u zlomenin proximálního konce femuru. Acta Chir Othop Traumatol Cech 1998;2:84–99.

30. De Lucas P, Seral B, Beano Á, Almodóvar JA, Domínguez I, et al. Fractures of the proximal femur. The Gamma nail versus plate. Osteo Trauma Care 2005;13:18–25.

31. Valverde JA, Alonso MG, Porro JG, Rueda D, Larrauri PM, et al. Use of the Gamma nail in the treatment of fractures of the proximal femur. Clin Orthop Rel Res 1998;350:56–61.

32. Hardy DC, Descamps PY, Krallis P. Use of intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. J Bone Joint Surg 1998;80– A:618–630.

33. Klanke J, Franke J, Westermann K. The titanium Gamma nail as routine treatment of pertrochanteric femoral fractures. Osteo Trauma Care 2005;13:26–33.

34. Lacroix H, Arwert H, Snijders CJ, Fontijne WJP. Prevention of fracture at the distal locking site of the Gamma nail. J Bone Joint Surg 1995;77–B:274–276.

35. Rosenblum SH, Zuckerman JD, Kummer FJ, Tam BS. A mechanical evaluation of the Gamma nail. J Bone Joint Surg 1992; 74–B:352–357.