Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2014 Aug;49(4):272-277. Korean.
    Published online Aug 27, 2014.
    https://doi.org/10.4055/jkoa.2014.49.4.272
    Copyright © 2014 by The Korean Orthopaedic Association
    Original Article

    Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture

    Hong Moon Sohn, M.D., Gwang Chul Lee, M.D., and Chae Won Lim, M.D.
      • Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.
    • Correspondence to: Gwang Chul Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. TEL: +82-62-220-3147, FAX: +82-62-226-3379, Email: leekci@chosun.ac.kr
    Received September 02, 2013; Revised November 13, 2013; Accepted February 28, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    We attempted to determine the cause of iatrogenic fractures and to prevent their occurrence during nailing using lateral entry portal on femur shaft fracture.

    Materials and Methods

    We conducted a retrospective study of 160 patients who had been treated with nailing using a lateral entry portal for femur shaft fractures. We compared 18 patients (group 1) with iatrogenic fractures on the femur proximal portion with 18 patients (group 2) who had no fracture, and then surveyed and analyzed the characters of the fracture, position of the portal, nail size, and complications.

    Results

    In distribution of primary femur shaft fractures, there were eight cases of proximal portion, nine cases of mid-portion, and one case of distal portion. In that of iatrogenic fractures, there were nine cases of medial fractures, five cases of lateral fractures, four cases of anterior fractures. In the entry portal of group 1, mean 1.82 mm leaned to the lateral side in antero-posteriorview, mean 5 mm leaned to the anterior side in lateral view. Anterior leaning of the entry portal was statistically significant with iatrogenic fracture.

    Conclusion

    The more the entry portal leaned to the lateral and anterior side, the greater the frequency of occurrence of iatrogenic fractures. To prevent iatrognic fracture, through preoperative X-ray, we must have a precise understanding and measure anatomical bowing and variance of the femur, and must pay attention to operative procedures during the operation.

    Keywords
    femoral fractures; intramedullary fracture fixation; iatrogenic fracture

    Figures

    Figure 1
    (A) Anteroposterior and lateral radiograph of a 27-year-old male injured in a car traffic accident, resulting in a femur midshaft fracture. (B) Postoperative radiographs show iatrogenic fracture of the medial cortex (black arrow) during closed nailing using a lateralized portal on the trochanteric tip (white arrow).

    Tables

    Table 1
    Summary of Cases

    Table 2
    Difference between GT Tip and Real Nail Insertion Site

    Notes

    This study was supported by research fund from Chosun University, 2013.

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    MeSH Terms
    Femoral Fractures
    Femur*
    Fracture Fixation, Intramedullary
    Humans
    Retrospective Studies
    Surgical Procedures, Operative
    Metrics
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