Outcomes of Combined Neck and Trochanter Fractures of the Femur Treated with Cephallomedullary Nail in Elderly

Abstract

PurposeProximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients.Materials and MethodsFrom January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study.ResultsAll patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems.ConclusionEighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

“…The region between the greater and lesser trochanter composed of dense trabecular bone is known as the intertrochanteric (IT) region of the femur [1]. IT fractures, defined as fractures that involve the proximal portion of the femur in the IT region, rank as the most prevalent type of extracapsular fracture of the proximal femur [2,3]. Among this common fracture type, it should be noted that a peri-trochanteric fracture with an extension into the ipsilateral femoral neck is relatively rare, with considerably few cases reported since 1989 [4][5][6].…”

Biomechanical analysis analyzing association between bone mineral density and lag screw migration

“…Theoretically, the trabecular bone surrounding the helical blade may function to resist further advancement of the lag screw. Therefore, it can be hypothesized that in the femoral head with weak bone strength, resistance may not be sufficient to prevent medial migration 26 , 27 .…”

Ipsilateral Femoral Neck and Trochanter Fracture: A Case Report and Literature Review

“…However, many therapeutical options were reported in the literature. Yoo et al published a retrospective study highlighting the interest of cephalomedullary nailing, using PFNA II nail, in the treatment of this injury in elderly patients [4]. The complete union of the fracture was observed in 85 % of cases.…”