Published online Apr 30, 2009.
https://doi.org/10.12671/jkfs.2009.22.2.123
Minimally Invasive Plate Osteosynthesis of Subtrochanteric Femoral Fractures
Fig. 1
(B) The surgical darping was done for both legs to have a better evaluation of postoperative alignment. (C) After the insertion of a flexible nail from the distal segment, a preliminary reduction was achieved. (D, E) Then, half-pins were fixed on the anterior aspect of proximal and distal segments, with assembling with an external fixator. A LCP-DF was inserted through the proximal submuscular tunnel. (F, G, H) A butterfly fragment was fixed with a lag screw by the help of collinear clamp. (I, J) Satisfactory alignment was achieved postoperatively and a bridging callus was seen at 6 months postoperatively.
(A) A 54 year-old man had a comminuted subtrochanteric femur.
Fig. 2
(B) Initially, the proximal segment was internally rotated with the help of half-pin. (C) This makes a better idea to have a preliminary reduction. The flexible nail technique was used. (D) A locking plate was inserted through the proximal submuscular tunnel (arrow). (E, F, G) A fine tuning of remained displacement was done by pulling the distal segment with a half-pin (arrows). (H, I) Postoperatively, satisfactory alignment was achieved without touching the middle fragment. (J) A successful union with a good bridging callus at 8 months postoperatively.
(A) A 34 year-old woman with a comminuted subtrochanteric femur.
Fig. 3
(B) The patient had multiple rib fractures with lung contusion, which made the choice of plating rather than nailing. Colinear clamp made a successful reduction, (C, D) followed by the percutaneous lag screws. (E) After insertion of a locking plate through the submuscular tunnel, (F, G) screws were fixed percutaneouosly. (H) Postoperatively, good alignment was achieved. (I, J, K, L) Union occurred at 6 months postoperatively, with a good functional outcome.
(A) A 40 year-old man with a spiral fracture of subtrochanteric femur.
References
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Oh CW, Oh JK, Kim SJ, et al. Minimally invasive plate osteosynthesis for comminuted subtrochanteric fracture of the femur. J Korean Fract Soc 2006;19:407–411.
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Saarenpää I, Heikkinen T, Jalovaara P. Treatment of subtrochanteric fractures. A comparison of the gamma nail and the dynamic hip screw: short-term outcome in 58 patients. Int Orthop 2007;31:65–70.
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Sohn OJ, Kim SD, Kim IW, Byun SJ. A comparative study of trochanteric fractures treated with the intertrochanteric/subtrochanteric fixation or the proximal femoral nail. J Korean Fract Soc 2006;19:303–308.
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