A Clinical Study of the Subtrochanteric Fractures of the Femur
10.4055/jkoa.1989.24.2.421
- Author:
Ik Dong KIM
;
Soo Young LEE
;
Poong Taek KIM
;
Byung Chul PARK
;
Young Wook CHOI
;
Hee Cheon KANG
- Publication Type:Original Article
- Keywords:
Subtrochanteric fracture;
Jewett nail
- MeSH:
Accidents, Traffic;
Clinical Study;
Congenital Abnormalities;
Craniocerebral Trauma;
Extremities;
Female;
Femur;
Hip;
Hip Fractures;
Humans;
Male;
Muscles;
Pelvic Bones;
Weight-Bearing
- From:The Journal of the Korean Orthopaedic Association
1989;24(2):421-428
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The subtrochanteric fracture of the femur is often comminuted because the subtrochanteric area is composed mainly of cortical bone and high compression force biomechanically and its proximal fragment is severely displaced by adjacent strong muscles. Therefore, it is difficult to maintain accurate reduction and rigid fixation and delayed or nonunion, limb shortening, varus deformity, metal failure, and many other problems can be encountered. Although various devices of internal fixation have been developed to solve these problems, we found many problems to select the fixation device in different fracture type properly. We studied 40 subtrochanteric fractures treated with various devices at our hospital from 1981 to Feb. 1987. The results were obtained as follows: 1. Male (28 patients, 70%) was predominant. The majority of patients (representing 55%) were between 31 and 60 years of age. While 10 of 12 female patients were after 50 years of age. 2. In 36 of 40 patients, the fracture resulted from high energy trauma, traffic accident or fall from height. 3. Pelvic bone fracture (4 cases)and head trauma (3 cases) were the most common associated injuries. 4. Fielding's type II(19 cases) fracture and Seinsheimer's type IV (10 cases) & V (9 cases) fractures were most common. 5. Of the 40 cases, 38(95%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 23 cases (60.5%) 6. The average time from operation to partial weight bearing was 12.2 weeks. 7. The mean duration of bony union was 25 weeks. And more longer period was needed in union as fractures goes distally 8. Of the 40 cases, 4 (10%) complications occured, those are : metal failure and fixation screw loosening (2 cases), infection (1 case), varus deformity (1 case). 9. From these series, these fractures should be treated as rigid internal fixation and Jewett nail or many other devices such as compression hip screw, condylar plate, or Judet plate could be applied successfully for the rigid fixation of subtrochanteric fractures of the femur according to the fracture displacement and stability.
