Skip to main content

Advertisement

SpringerLink
Log in

Blocking screw (pin) technique to achieve an acceptable reduction in intramedullary of subtrochanteric femoral fractures: indications, techniques, and clinical outcomes

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Subtrochanteric femur fractures treated with intramedullary nails present biomechanical benefits, early weight-bearing, and reduced soft tissue damage, promoting bone union. However, improper reduction due to muscular forces and fragmented proximal bone increases nonunion risk. This study evaluates the efficacy of the blocking screw technique in preventing malalignment during intramedullary nailing.

Material and methods

In cases of subtrochanteric femoral fractures where malalignment, such as varus and anterior angulation, was anticipated during intramedullary nailing, proper reduction was ensured using blocking screw technique on the proximal bone fragment from the coronal or sagittal plane. A retrospective analysis was conducted on 25 patients (14 males, 11 females; average age 55.12 years) who were followed up for more than 1 year. The postoperative neck-shaft angle, anterior angulation angle, and limb length discrepancy were compared radiologically with those on the healthy side, and the presence and duration of bone union were measured. The Harris hip score was used for functional evaluation, and complications, including infection, were analyzed.

Results

At the final follow-up, primary bone union was achieved in 21/25 patients (84%), with an average bone union time of 21.81 weeks (range, 14–42 weeks). Of the four nonunions, bone union was achieved in three cases through bone grafting and supplemental plating and in the other case through intramedullary exchange, supplemental plating, and bone grafting. The femoral neck-shaft angle and anterior angulation showed no statistically significant differences compared with the healthy side, with averages of − 1.15° and − 1.4°, respectively. The limb length discrepancy was an average of − 2.4 mm. Regarding functional outcomes, the Harris hip score averaged 89.52 points (range 82–94 points).

Conclusions

In subtrochanteric femoral fractures, the blocking screw technique effectively prevents malalignment during intramedullary nailing, ensuring not only appropriate reduction but also high bone union rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Giannoudis PV, Ahmad MA, Mineo GV, Tosounidis TI, Calori GM, Kanakaris NK (2013) Subtrochanteric fracture non-unions with implant failure managed with the “Diamond” concept. Injury 44:S76-81

    Article  PubMed  Google Scholar 

  2. Celebi L, Can M, Muratli H, Yagmurlu M, Yuksel H, Bicimoğlu A (2006) Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury 37:740–750

    Article  CAS  PubMed  Google Scholar 

  3. Grønhaug KML, Dybvik E, Matre K, Östman B, Gjertsen JE (2023) Comparison of intramedullary nails in the treatment of trochanteric and subtrochanteric fractures: an observational study of 13, 232 fractures in the Norwegian hip fracture register. J Bone Joint Surg Am 105:1227–1236

    Article  PubMed  Google Scholar 

  4. Kim JW, Oh CW, Park KH, Oh JK, Yoon YC, Hong W et al (2023) The role of an augmentative plating in the management of femoral subtrochanteric nonunion. Arch Orthop Trauma Surg 143:4915–4919

    Article  PubMed  Google Scholar 

  5. Toridis TG (1969) Stress analysis of the femur. J Biomech 2:163–174

    Article  CAS  PubMed  Google Scholar 

  6. Xie H, Xie L, Wang J, Chen C, Zhang C, Zheng W (2019) Intramedullary versus extramedullary fixation for the treatment of subtrochanteric fracture: a systematic review and meta-analysis. Int J Surg 63:43–57

    Article  PubMed  Google Scholar 

  7. Lee PC, Hsieh PH, Yu SW, Shiao CW, Kao HK, Wu CC (2007) Biologic plating versus intramedullary nailing for comminuted subtrochanteric fractures in young adults: a prospective, randomized study of 66 cases. J Trauma 63:1283–1291

    PubMed  Google Scholar 

  8. Imerci A, Canbek U, Karatosun V, Karapınar L, Yeşil M (2015) Nailing or plating for subtrochanteric femoral fractures: a non-randomized comparative study. Eur J Orthop Surg Traumatol 25:889–894

    Article  PubMed  Google Scholar 

  9. Burnei C, Popescu G, Barbu D, Capraru F (2011) Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures. J Med Life 4:324–329

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Panteli M, Vun JS, West RM, Howard A, Pountos I, Giannoudis PV (2022) Subtrochanteric femoral fractures and intramedullary nailing complications: a comparison of two implants. J Orthop Traumatol 23:27

    Article  PubMed  PubMed Central  Google Scholar 

  11. von Rüden C, Hungerer S, Augat P, Trapp O, Bühren V, Hierholzer C (2015) Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures. Arch Orthop Trauma Surg 135:179–185

    Article  Google Scholar 

  12. Damany D, Parker M, Gurusamy K, Upadhyay P (2006) Complications of subtrochanteric fractures. A meta-analysis of 39 studies involving 1835 fractures. Orthop Proc 88:168–168

    Google Scholar 

  13. Lundy DW (2007) Subtrochanteric femoral fractures. J Am Acad Orthop Surg 15:663–671

    Article  PubMed  Google Scholar 

  14. Kasha S, Yalamanchili RK (2020) Management of subtrochanteric fractures by nail osteosynthesis: a review of tips and tricks. Int Orthop 44:645–653

    Article  PubMed  Google Scholar 

  15. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium—2018. J Orthop Trauma 32:S1–S10

    Article  PubMed  Google Scholar 

  16. Yoon RS, Donegan DJ, Liporace FA (2015) Reducing subtrochanteric femur fractures: tips and tricks, do’s and don’ts. J Orthop Trauma 29:S28–S33

    Article  PubMed  Google Scholar 

  17. Yoon YC, Oh CW, Sim JA, Oh JK (2020) Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures. Injury 51:400–406

    Article  PubMed  Google Scholar 

  18. Garrison I, Domingue G, Honeycutt MW (2021) Subtrochanteric femur fractures: current review of management. EFORT Open Rev 6:145–151

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gavaskar A, Srinivasan P, Balamurugan J, Raj RV, Sagar K, Kirubakaran P (2021) Retrograde entry portal for cephalomedullary nailing in difficult subtrochanteric fractures. Injury 52:2010–2015

    Article  PubMed  Google Scholar 

  20. Yoon YC, Oh CW, Oh JK (2020) An intuitive and simple technique for accurate insertion point selection and precise Poller (blocking) screw insertion. Arch Orthop Trauma Surg 140:1431–1435

    Article  PubMed  Google Scholar 

  21. Guo J, Zha J, Di J, Yin Y, Hou Z, Zhang Y (2021) Outcome analysis of intramedullary nailing augmented with Poller screws for treating difficult reduction fractures of femur and tibia: a retrospective cohort study. BioMed Res Int 2021:6615776

    PubMed  PubMed Central  Google Scholar 

  22. Yoon YC, Oh CW, Kim JW, Park KH, Oh JK, Ha SS (2022) Poller (blocking) screw with intramedullary femoral nailing for subtrochanteric femoral non-unions: clinical outcome and review of concepts. Eur J Trauma Emerg Surg 48:1295–1306

    Article  PubMed  Google Scholar 

  23. Seinsheimer F (1978) Subtrochanteric fractures of the femur. J Bone Joint Surg Am 60:300–306

    Article  CAS  PubMed  Google Scholar 

  24. Wang Z, Li K, Gu Z, Fan H, Li H (2021) The risk assessment model of fracture nonunion after intramedullary nailing for subtrochanteric femur fracture. Medicine 100:e25274

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Lotzien S, Rausch V, Schildhauer TA, Gessmann J (2018) Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw. BMC Musculoskelet Disord 19:1–12

    Article  Google Scholar 

  26. Barquet A, Mayora G, Fregeiro J, López L, Rienzi D, Francescoli L (2004) The treatment of subtrochanteric nonunions with the long gamma nail: twenty-six patients with a minimum 2-year follow-up. J Orthop Trauma 18:346–353

    Article  PubMed  Google Scholar 

  27. Kim JW, Kim JJ, Byun Y-S, Shon OJ, Oh HK, Park KC et al (2017) Factors affecting fracture location in atypical femoral fractures: a cross-sectional study with 147 patients. Injury 48:1570–1574

    Article  PubMed  Google Scholar 

  28. Rhorer AS (2009) Percutaneous/minimally invasive techniques in treatment of femoral shaft fractures with an intramedullary nail. J Orthop Trauma 23:S2–S5

    Article  PubMed  Google Scholar 

  29. Hannah A, Aboelmagd T, Yip G, Hull P (2014) A novel technique for accurate Poller (blocking) screw placement. Injury 45:1011–1014

    Article  PubMed  Google Scholar 

  30. Pape HC, Tarkin IS (2009) Intraoperative reduction techniques for difficult femoral fractures. J Orthop Trauma 23:S6–S11

    Article  PubMed  Google Scholar 

  31. Koch JC (1917) The laws of bone architecture. Am J Anat 21:177–298

    Article  Google Scholar 

  32. Sims SH (2002) Subtrochanteric femoral fractures. Orthop Clin North Am 33:113–126

    Article  PubMed  Google Scholar 

  33. Fielding JW, Cochran GVB, Zickel RE (1974) Biomechanical characteristics and surgical management of subtrochanteric fractures. Orthop Clin North Am 5:629–650

    Article  CAS  PubMed  Google Scholar 

  34. Streubel PN, Wong AH, Ricci WM, Gardner MJ (2011) Is there a standard trochanteric entry site for nailing of subtrochanteric femur fractures? J Orthop Trauma 25:202–207

    Article  PubMed  Google Scholar 

  35. Lee SJ, Lee SH, Park SS, Park HS (2015) Treatment of femur subtrochanteric fracture using the intramedullary long nail; comparison of closed reduction and minimal open reduction. J Korean Orthop Assoc 50:18–24

    Article  Google Scholar 

  36. Robinson CM, Houshian S, Khan L (2005) Trochanteric-entry long cephalomedullary nailing of subtrochanteric fractures caused by low-energy trauma. J Bone Joint Surg Am 87:2217–2226

    PubMed  Google Scholar 

  37. Shukla S, Johnston P, Ahmad M, Wynn-Jones H, Patel A, Walton N (2007) Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 38:1286–1293

    Article  PubMed  Google Scholar 

  38. Wang J, Li H, Jia H, Ma X (2020) Intramedullary versus extramedullary fixation in the treatment of subtrochanteric femur fractures: a comprehensive systematic review and meta-analysis. Acta Orthop Traumatol Turc 54:639–646

    Article  PubMed  PubMed Central  Google Scholar 

  39. Stedtfeld H-W, Mittlmeier T, Landgraf P, Ewert A (2004) The logic and clinical applications of blocking screws. J Bone Joint Surg Am 86:17–25

    Article  PubMed  Google Scholar 

  40. Van Dyke B, Colley R, Ottomeyer C, Palmer R, Pugh K (2018) Effect of blocking screws on union of infraisthmal femur fractures stabilized with a retrograde intramedullary nail. J Orthop Trauma 32:251–255

    Article  PubMed  Google Scholar 

  41. Auston D, Donohue D, Stoops K, Cox J, Diaz M, Santoni B et al (2018) Long segment blocking screws increase the stability of retrograde nail fixation in geriatric supracondylar femur fractures: eliminating the “bell-clapper effect.” J Orthop Trauma 32:559–564

    Article  PubMed  Google Scholar 

  42. Krettek C, Stephan C, Schandelmaier P, Richter M, Pape H (1999) The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br 81:963–968

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Number: HR22C1832).

Funding

The study did not receive funding from any source.

Author information

Authors and Affiliations

  1. Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Namdong-gu, Incheon, Republic of Korea

    Yong-Cheol Yoon

  2. Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok‑ro, Jung‑gu, Daegu, 41944, Republic of Korea

    Chang-Wug Oh, Joon-Woo Kim, Sung-Hyuk Yoon & Hyun Woo Kim

  3. Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore

    Daniel W. R. Seng

Authors
  1. Yong-Cheol Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang-Wug Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joon-Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel W. R. Seng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sung-Hyuk Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang-Wug Oh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the institutional Ethics Committee of the Kyungpook National University Hospital (IRB No : KNUH 2023-07-043).

Informed consent

Informed consent was obtained from all individual participants and/or their families.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoon, YC., Oh, CW., Kim, JW. et al. Blocking screw (pin) technique to achieve an acceptable reduction in intramedullary of subtrochanteric femoral fractures: indications, techniques, and clinical outcomes. Arch Orthop Trauma Surg 144, 763–771 (2024). https://doi.org/10.1007/s00402-023-05156-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-05156-7

Keywords

Search

Navigation