Effectiveness analysis of surgical treatment of ipsilateral femoral neck fracture and subtrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Qi , LI Gen , GE Wei , LU Guanghua ,  CAI Ming ,  LI Shaohua

Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, 200072, P.R.China;

Corresponding author：

CAI Ming, Email: cmdoctor@tongji.edu.cn; LI Shaohua, Email: tjdxsq@tongji.edu.cn

Keywords：

Subtrochanteric fracture; femoral neck fracture; intramedullary nail; cable wiring; internal fixation

DOI：

10.7507/1002-1892.201702069

Video：

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Objective To discuss the effectiveness of intramedullary nail fixation with selective cable wiring in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture. Methods Between June 2012 and December 2015, a total of 19 patients with ipsilateral femoral neck fracture and subtrochanteric fracture underwent closed reduction of femoral neck fracture and intramedullary nail fixation combined with selective cable wiring. There were 5 males and 14 females with a median age of 52 years (range, 35-77 years). The cause of injury included traffic accident injury in 17 cases and falling injury in 2 cases. According to Garden classification for femoral neck fractures, 7 cases were rated as type Ⅱ, 8 as type Ⅲ, and 4 as type Ⅳ. Femoral subtrochanteric fractures were classified by Seinsheimer classification, with 9 cases as type Ⅱ, 5 as type Ⅲ, 3 as type Ⅳ, and 2 as type V. The interval from injury to operation ranged from 2 to 7 days with an average of 3.7 days. Results The operation time was 58-125 minutes (mean, 82.4 minutes) and the intraoperative blood loss was 225-725 mL (mean, 289.5 mL). All incisions achieved healing by first intention and no early complication such as infection was observed. All patients were followed up 12-18 months (mean, 13.9 months). At 1 month after operation, the tip apex distance was 9-23 mm (mean, 15.2 mm). All patients achieved bone union with the healing time of 18-42 weeks (mean, 27.4 weeks). One case of hip varus and femoral neck re-displacement (femoral neck shaft angle was 122°) occurred at 3 months after operation, which achieved bone union at 42 weeks after operation. Five patients complained of postoperative pain with the visual analogue scale (VAS) score of 1-3 (mean, 1.8), which did not influence normal life. A total of 16 patients recovered preoperative hip function. During follow-up, no fracture nonunion, femoral head necrosis, implant failure, screw cut-out, and loosening of cable wiring was observed. The Harris hip score (HSS) was 72-92 (mean, 82.8) at last follow-up and 15 patients (78.9%) achieved good hip function. Conclusion Intramedullary nail fixation combined with selective cable wiring was effective in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture.

Citation： SUN Qi, LI Gen, GE Wei, LU Guanghua, CAI Ming, LI Shaohua. Effectiveness analysis of surgical treatment of ipsilateral femoral neck fracture and subtrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1043-1048. doi: 10.7507/1002-1892.201702069 Copy

1.	Matsushita M. Hip Fracture—Epidemiology, Management and Liaison Service. Prevention of the secondary hip fractures utilizing the regional post-referral treatment plan. Clin Calcium, 2015, 25(4): 545-550.
2.	Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma, 2009, 23(1): 22-30.
3.	Peljovich AE, Patterson BM. Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg, 1998, 6(2): 106-113.
4.	Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures: complications and their treatment. Clin Orthop Relat Res, 2002, (399): 78-86.
5.	Mingo-Robinet J, Torres-Torres M, Moreno-Barrero M, et al. Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results. Injury, 2015, 46(6): 1036-1041.
6.	Kang JS, Moon KH, Shin JS, et al. Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures. Clin Orthop Surg, 2016, 8(2): 146-152.
7.	Mir HR, Edwards P, Sanders R, et al. Results of cephallomedullary nail fixation for displaced intracapsular femoral neck fractures. J Orthop Trauma, 2011, 25(12): 714-720.
8.	Chaturvedi S, Sahu SC. Ipsilateral concomitant fractures of the femoral neck and shaft. Injury, 1993, 24(4): 243-246.
9.	Bucholz RW, Rathjen K. Concomitant ipsilateral fractures of the hip and femur treated with interlocking nails. Orthopedics, 1985, 8(11): 1402-1406.
10.	Hak DJ, Mauffrey C, Hake M, et al. Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics, 2015, 38(4): 247-251.
11.	Bedi A, Karunakar MA, Caron T, et al. Accuracy of reduction of ipsilateral femoral neck and shaft fractures—an analysis of various internal fixation strategies. J Orthop Trauma, 2009, 23(4): 249-253.
12.	Hung SH, Hsu CY, Hsu SF, et al. Surgical treatment for ipsilateral fractures of the hip and femoral shaft. Injury, 2004, 35(2): 165-169.
13.	Boulton CL, Pollak AN. Special topic: Ipsilateral femoral neck and shaft fractures—does evidence give us the answer? Injury, 2015, 46(3): 478-483.
14.	Jain P, Maini L, Mishra P, et al. Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures. Injury, 2004, 35(10): 1031-1038.
15.	Singh R, Rohilla R, Magu NK, et al. Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol, 2008, 9(3): 141-147.
16.	Garnavos C, Peterman A, Howard PW. The treatment of difficult proximal femoral fractures with the Russell-Taylor reconstruction nail. Injury, 1999, 30(6): 407-415.
17.	Ekstrom W, Karlsson-Thur C, Larsson S, et al. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma, 2007, 21(1): 18-25.
18.	Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am, 2004, 35(4): 473-483.
19.	Rahme DM, Harris IA. Intramedullary nailing versus fixed angle blade plating for subtrochanteric femoral fractures: a prospective randomised controlled trial. J Orthop Surg (Hong Kong), 2007, 15(3): 278-281.
20.	Collinge CA, Hymes R, Archdeacon M, et al. Unstable Proximal Femur Fractures Treated With Proximal Femoral Locking Plates: A Retrospective, Multicenter Study of 111 Cases. J Orthop Trauma, 2016, 30(9): 489-495.
21.	Tencer AF, Johnson KD, Johnston DW, et al. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res, 1984, 2(3): 297-305.
22.	Liu P, Wu X, Shi H, et al. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis. Clin Interv Aging, 2015, 10: 803-811.
23.	Celebi L, Can M, Muratli HH, et al. Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury, 2006, 37(8): 740-750.
24.	Siebenrock KA, Müller U, Ganz R. Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury, 1998, 29 Suppl 3: C7-15.
25.	Shih KS, Hsu CC, Hsu TP. A biomechanical investigation of the effects of static fixation and dynamization after interlocking femoral nailing: a finite element study. J Trauma Acute Care Surg, 2012, 72(2): E46-53.
26.	Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
27.	Omerovic D, Lazovic F, Hadzimehmedagic A. Static or dynamic intramedullary nailing of femur and tibia. Med Arch, 2015, 69(2): 110-113.
28.	Karakaşli A, Satoğlu IS, Havitioğlu H. A new intramedullary sustained dynamic compression nail for the treatment of long bone fractures: a biomechanical study. Eklem Hastalik Cerrahisi, 2015, 26(2): 64-71.
29.	Herrera-Soto JA, Meuret R, Phillips JH, et al. The management of pediatric subtrochanteric femur fractures with a statically locked intramedullary nail. J Orthop Trauma, 2015, 29(1): e7-e11.
30.	Erez O, Dougherty PJ. Early complications associated with cephalomedullary nail for intertrochanteric hip fractures. J Trauma Acute Care Surg, 2012, 72(2): E101-105.
31.	Matre K, Vinje T, Havelin LI, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg (Am), 2013, 95(3): 200-208.
32.	Tsai CH, Hsu HC, Fong YC, et al. Treatment for ipsilateral fractures of femoral neck and shaft. Injury, 2009, 40(7): 778-782.
33.	Beingessner DM, Scolaro JA, Orec RJ, et al. Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases. Injury, 2013, 44(12): 1910-1915.
34.	Jain NB, Losina E, Ward DM, et al. Trends in surgical management of femoral neck fractures in the United States. Clin Orthop Relat Res, 2008, 466(12): 3116-3122.
35.	Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-259.
36.	Riehl JT, Widmaier JC. Techniques of obtaining and maintaining reduction during nailing of femur fractures. Orthopedics, 2009, 32(8): 581.
37.	Hernández-Vaquero D, Pérez-Hernández D, Suárez-Vázquez A, et al. Reverse oblique intertrochanteric femoral fractures treated with the gamma nail. Int Orthop, 2005, 29(3): 164-167.
38.	Hoskins W, Bingham R, Joseph S, et al. Subtrochanteric fracture: the effect of cerclage wire on fracture reduction and outcome. Injury, 2015, 46(10): 1992-1995.
39.	Müller T, Topp T, Kühne CA, et al. The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop, 2011, 35(8): 1237-1243.
40.	Ban I, Birkelund L, Palm H, et al. Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures: 4 reoperations in 60 patients followed for 1 year. Acta Orthop, 2012, 83(3): 240-243.
41.	Renner N, Wieser K, Lajtai G, et al. Stainless steel wire versus FiberWire suture cerclage fixation to stabilize the humerus in total shoulder arthroplasty. J Shoulder Elbow Surg, 2014, 23(10): 1568-1574.
42.	Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg (Br), 2002, 84(8): 1093-1110.

1. Matsushita M. Hip Fracture—Epidemiology, Management and Liaison Service. Prevention of the secondary hip fractures utilizing the regional post-referral treatment plan. Clin Calcium, 2015, 25(4): 545-550.
2. Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma, 2009, 23(1): 22-30.
3. Peljovich AE, Patterson BM. Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg, 1998, 6(2): 106-113.
4. Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures: complications and their treatment. Clin Orthop Relat Res, 2002, (399): 78-86.
5. Mingo-Robinet J, Torres-Torres M, Moreno-Barrero M, et al. Minimally invasive clamp-assisted reduction and cephalomedullary nailing without cerclage cables for subtrochanteric femur fractures in the elderly: Surgical technique and results. Injury, 2015, 46(6): 1036-1041.
6. Kang JS, Moon KH, Shin JS, et al. Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures. Clin Orthop Surg, 2016, 8(2): 146-152.
7. Mir HR, Edwards P, Sanders R, et al. Results of cephallomedullary nail fixation for displaced intracapsular femoral neck fractures. J Orthop Trauma, 2011, 25(12): 714-720.
8. Chaturvedi S, Sahu SC. Ipsilateral concomitant fractures of the femoral neck and shaft. Injury, 1993, 24(4): 243-246.
9. Bucholz RW, Rathjen K. Concomitant ipsilateral fractures of the hip and femur treated with interlocking nails. Orthopedics, 1985, 8(11): 1402-1406.
10. Hak DJ, Mauffrey C, Hake M, et al. Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics, 2015, 38(4): 247-251.
11. Bedi A, Karunakar MA, Caron T, et al. Accuracy of reduction of ipsilateral femoral neck and shaft fractures—an analysis of various internal fixation strategies. J Orthop Trauma, 2009, 23(4): 249-253.
12. Hung SH, Hsu CY, Hsu SF, et al. Surgical treatment for ipsilateral fractures of the hip and femoral shaft. Injury, 2004, 35(2): 165-169.
13. Boulton CL, Pollak AN. Special topic: Ipsilateral femoral neck and shaft fractures—does evidence give us the answer? Injury, 2015, 46(3): 478-483.
14. Jain P, Maini L, Mishra P, et al. Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures. Injury, 2004, 35(10): 1031-1038.
15. Singh R, Rohilla R, Magu NK, et al. Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol, 2008, 9(3): 141-147.
16. Garnavos C, Peterman A, Howard PW. The treatment of difficult proximal femoral fractures with the Russell-Taylor reconstruction nail. Injury, 1999, 30(6): 407-415.
17. Ekstrom W, Karlsson-Thur C, Larsson S, et al. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma, 2007, 21(1): 18-25.
18. Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am, 2004, 35(4): 473-483.
19. Rahme DM, Harris IA. Intramedullary nailing versus fixed angle blade plating for subtrochanteric femoral fractures: a prospective randomised controlled trial. J Orthop Surg (Hong Kong), 2007, 15(3): 278-281.
20. Collinge CA, Hymes R, Archdeacon M, et al. Unstable Proximal Femur Fractures Treated With Proximal Femoral Locking Plates: A Retrospective, Multicenter Study of 111 Cases. J Orthop Trauma, 2016, 30(9): 489-495.
21. Tencer AF, Johnson KD, Johnston DW, et al. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res, 1984, 2(3): 297-305.
22. Liu P, Wu X, Shi H, et al. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis. Clin Interv Aging, 2015, 10: 803-811.
23. Celebi L, Can M, Muratli HH, et al. Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury, 2006, 37(8): 740-750.
24. Siebenrock KA, Müller U, Ganz R. Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury, 1998, 29 Suppl 3: C7-15.
25. Shih KS, Hsu CC, Hsu TP. A biomechanical investigation of the effects of static fixation and dynamization after interlocking femoral nailing: a finite element study. J Trauma Acute Care Surg, 2012, 72(2): E46-53.
26. Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
27. Omerovic D, Lazovic F, Hadzimehmedagic A. Static or dynamic intramedullary nailing of femur and tibia. Med Arch, 2015, 69(2): 110-113.
28. Karakaşli A, Satoğlu IS, Havitioğlu H. A new intramedullary sustained dynamic compression nail for the treatment of long bone fractures: a biomechanical study. Eklem Hastalik Cerrahisi, 2015, 26(2): 64-71.
29. Herrera-Soto JA, Meuret R, Phillips JH, et al. The management of pediatric subtrochanteric femur fractures with a statically locked intramedullary nail. J Orthop Trauma, 2015, 29(1): e7-e11.
30. Erez O, Dougherty PJ. Early complications associated with cephalomedullary nail for intertrochanteric hip fractures. J Trauma Acute Care Surg, 2012, 72(2): E101-105.
31. Matre K, Vinje T, Havelin LI, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg (Am), 2013, 95(3): 200-208.
32. Tsai CH, Hsu HC, Fong YC, et al. Treatment for ipsilateral fractures of femoral neck and shaft. Injury, 2009, 40(7): 778-782.
33. Beingessner DM, Scolaro JA, Orec RJ, et al. Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases. Injury, 2013, 44(12): 1910-1915.
34. Jain NB, Losina E, Ward DM, et al. Trends in surgical management of femoral neck fractures in the United States. Clin Orthop Relat Res, 2008, 466(12): 3116-3122.
35. Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-259.
36. Riehl JT, Widmaier JC. Techniques of obtaining and maintaining reduction during nailing of femur fractures. Orthopedics, 2009, 32(8): 581.
37. Hernández-Vaquero D, Pérez-Hernández D, Suárez-Vázquez A, et al. Reverse oblique intertrochanteric femoral fractures treated with the gamma nail. Int Orthop, 2005, 29(3): 164-167.
38. Hoskins W, Bingham R, Joseph S, et al. Subtrochanteric fracture: the effect of cerclage wire on fracture reduction and outcome. Injury, 2015, 46(10): 1992-1995.
39. Müller T, Topp T, Kühne CA, et al. The benefit of wire cerclage stabilisation of the medial hinge in intramedullary nailing for the treatment of subtrochanteric femoral fractures: a biomechanical study. Int Orthop, 2011, 35(8): 1237-1243.
40. Ban I, Birkelund L, Palm H, et al. Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures: 4 reoperations in 60 patients followed for 1 year. Acta Orthop, 2012, 83(3): 240-243.
41. Renner N, Wieser K, Lajtai G, et al. Stainless steel wire versus FiberWire suture cerclage fixation to stabilize the humerus in total shoulder arthroplasty. J Shoulder Elbow Surg, 2014, 23(10): 1568-1574.
42. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg (Br), 2002, 84(8): 1093-1110.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of surgical treatment of ipsilateral femoral neck fracture and subtrochanteric fracture

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