Purpose: This paper aims to evaluate the postoperative outcomes of femoral trochanteric fractures with fracture lines extending to the base of the femoral neck (Type 2-3 fractures), treated with intramedullary nails featuring double screws into the femoral head. Methods: A multicenter prospective study enrolled 225 patients with proximal femoral fractures. Type 2-3 fractures were classified based on the Area classification using 3D-CT. We compared surgical outcomes among three types of short femoral nails with double lag screws. Results: Type 2-3 fractures accounted for 28.4% of cases. Among them, 79.7% were treated with nails incorporating double lag screws. No significant differences were found in failure rate, reduction quality, or operative parameters among different implant types. Conclusion: Good postoperative outcomes were achieved in Type 2-3 fractures using intramedullary nails with double screws into the femoral head, regardless of implant brand.
References
[1]
Japanese Orthopaedic Association (JOA) (2021) Clinical Practice Guideline on the Diagnosis. Treatment of Femoral Neck and Trochanteric Fractures. 3rd Edition, Nankodo, 22. (In Japanese)
[2]
Kijima, H., Yamada, S., Konishi, N., Kubota, H., Tazawa, H., Tani, T., et al. (2016) The Choice of Internal Fixator for Fractures around the Femoral Trochanter Depends on Area Classification. SpringerPlus, 5, Article No. 1512. https://doi.org/10.1186/s40064-016-3206-1
[3]
Ito, J., Takakubo, Y., Sasaki, K., Sasaki, J., Owashi, K. and Takagi, M. (2015) Prevention of Excessive Postoperative Sliding of the Short Femoral Nail in Femoral Trochanteric Fractures. ArchivesofOrthopaedicandTraumaSurgery, 135, 651-657. https://doi.org/10.1007/s00402-015-2200-3
[4]
Kijima, H., Yamada, S., Konishi, N., Kubota, H., Tazawa, H., Tani, T., et al. (2014) The Reliability of Classifications of Proximal Femoral Fractures with 3-Dimensional Computed Tomography: The New Concept of Comprehensive Classification. AdvancesinOrthopedics, 2014, Article ID: 359689. https://doi.org/10.1155/2014/359689
[5]
Kijima, H., Yamada, S., Konishi, N., Kubota, H., Miyakoshi, N. and Shimada, Y. (2021) Clinical Outcomes of Fractures Affecting Both the Femoral Neck and Femoral Trochanter. Acta Orthopaedica Belgica, 87, 27-35.
[6]
Saarenpää, I., Partanen, J. and Jalovaara, P. (2002) Basicervical Fracture—A Rare Type of Hip Fracture. ArchivesofOrthopaedicandTraumaSurgery, 122, 69-72. https://doi.org/10.1007/s004020100306
[7]
Lee, Y., Yoon, B., Hwang, J.S., Cha, Y., Kim, K. and Koo, K. (2018) Risk Factors of Fixation Failure in Basicervical Femoral Neck Fracture: Which Device Is Optimal for Fixation? Injury, 49, 691-696. https://doi.org/10.1016/j.injury.2018.02.009
[8]
Kweon, S.H., Lee, S.H., Kook, S.H. and Choi, Y.C. (2017) Outcomes of Cephalomedullary Nailing in Basicervical Fracture. Hip&Pelvis, 29, 270-276. https://doi.org/10.5371/hp.2017.29.4.270
[9]
Johnson, J., Deren, M., Chambers, A., Cassidy, D., Koruprolu, S. and Born, C. (2019) Biomechanical Analysis of Fixation Devices for Basicervical Femoral Neck Fractures. JournaloftheAmericanAcademyofOrthopaedicSurgeons, 27, e41-e48. https://doi.org/10.5435/jaaos-d-17-00155
[10]
Guo, J., Dong, W., Jin, L., Yin, Y., Zhang, R., Hou, Z., et al. (2019) Treatment of Basicervical Femoral Neck Fractures with Proximal Femoral Nail Antirotation. JournalofInternationalMedicalResearch, 47, 4333-4343. https://doi.org/10.1177/0300060519862957
[11]
Larsson, S., Friberg, S. and Hansson, L. (1990) Trochanteric Fractures. ClinicalOrthopaedicsandRelatedResearch, 259, 130-139. https://doi.org/10.1097/00003086-199010000-00019
[12]
Tsukada, S., Okumura, G. and Matsueda, M. (2012) Postoperative Stability on Lateral Radiographs in the Surgical Treatment of Pertrochanteric Hip Fractures. ArchivesofOrthopaedicandTraumaSurgery, 132, 839-846. https://doi.org/10.1007/s00402-012-1484-9
[13]
Kozono, N., Ikemura, S., Yamashita, A., Harada, T., Watanabe, T. and Shirasawa, K. (2014) Direct Reduction May Need to Be Considered to Avoid Postoperative Subtype P in Patients with an Unstable Trochanteric Fracture: A Retrospective Study Using a Multivariate Analysis. ArchivesofOrthopaedicandTraumaSurgery, 134, 1649-1654. https://doi.org/10.1007/s00402-014-2089-2
[14]
Carr, J.B. (2007) The Anterior and Medial Reduction of Intertrochanteric Fractures: A Simple Method to Obtain a Stable Reduction. JournalofOrthopaedicTrauma, 21, 485-489. https://doi.org/10.1097/bot.0b013e31804797cf
