Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

Abstract

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

Valgus Malalignment Due to Internally Malrotated Trochanteric Nail Placement, with Rotational Malalignment in Femoral Shaft Segmental Fracture Fixation, an Underestimated Avoidable Technical Error: A Case Report

“…Proximal and distal third shaft fractures are associated with higher incidence of coronal malalignment 1 . Other causes leading to coronal malalignment include improper entry point of trochanteric nail, inadequate reduction of the fracture, deforming forces of the muscles acting on the bone segments, spacious canal of proximal and third fractures at metaphyseodiaphyseal junction 4,5 .…”

Improve the Efficiency of Surgery for Femoral Shaft Fractures with A Novel Instrument: A Randomized Controlled Trial

“…Closed reduction and antegrade intramedullary nailing internal fixation has become the standard method of treatment for femoral shaft fracture of the upper or middle segment [ 6 , 8 – 10 ]. However, surgeons must overcome 2 major difficulties during the operation.…”

Incidence of Varus Malalignment Post Interlocking Nail in Proximal Femur Shaft Fractures Comparing Two Types of Entry Points

“…As the greater trochanter is not collinear with the long axis of the femoral shaft, complications including varus malalignment and iatrogenic fracture comminution have been demonstrated to occur when nails designed for insertion through the piriformis fossa are inserted through the greater trochanter 3 . However, the favoured entry point for nails has been debated with advocates for both the piriformis fossa and greater trochanteric entry points 4 , 5 . The greater trochanteric entry point is technically easier due to the subcutaneous location of the greater trochanter, especially in obese patients 3 .…”

“…The greater trochanteric entry point is technically easier due to the subcutaneous location of the greater trochanter, especially in obese patients 3 . Furthermore, it is less sensitive to anteroposterior translation due to the more cancellous nature of the trochanteric area and it reduces risk of iatrogenic bursting of the proximal segment 4 . It also reduces the risk of damaging the blood supply to the femoral head because of its more lateral approach 4 .…”

“…Furthermore, it is less sensitive to anteroposterior translation due to the more cancellous nature of the trochanteric area and it reduces risk of iatrogenic bursting of the proximal segment 4 . It also reduces the risk of damaging the blood supply to the femoral head because of its more lateral approach 4 . Its potential disadvantages are iatrogenic fracture of the greater trochanter and varus malalignement 5 .…”