Abstract
Background: Reconstruction nail had developed since 1985. General indications reviewed from literatures are 1. Ipsilateral femoral neck-shaft fracture (nondisplaced), 2. Russell-Type IB subtrochanteric fracturtes (intact piriformis fossa, fractured less trochanter). Many authors did not recommend that application of reconstruction nail in displaced ipsilateral femoral neck-shaft fractures. The reason is that unpredictable femoral neck-shaft reduction and over-distraction of shaft fracture. We developed one new method for overcoming such technical puzzle to achieve one-step reduction for displaced ipsilateral femoral neck-shaft fractures.
Material: There are 24 consecutive cases were treated by reconstruction nail by the same operator in Chi-Mei Foundation Hospital from February, 1999 to June, 2000. Five of them were diagnosed as displaced ipsilateral femoral neck-shaft fractures and treating new surgical technique in reconstruction nailing. Initial radiographic assessment revealed displaced neck fracture can be classified as Garden III, the fracture morphology is vertical (Pauwell III). Average age of these five patients is 37.6 y/o. The sex distribution is M:F=3:2
Method: Provisional proximal fixation of femur is mandatory. First, we use two 5.0mm drillpit transfixed trochanter region after assure of femoral anteversion. Second, release of traction and distal locking for reduction and fixation of shaft fracture part. Third, remove application handle and use Internal rotation or other remote maneuver for restoration of neck-shaft angle. Finally, complete drilling through neck and sequent proximal cephalomedullary locking was performed by free-hand method.
Result: Initial reduction result was acceptable. There was no significant coxa-varus or coxa-brevis. Two of them had removed of implants and clinical result was satisfied. No avascular necrosis was noted in our following up.
Discussion: How to treat displaced ipsilateral femoral neck-shaft fractures in one-step was obstacle in our orthopedic practice. Abandonment of reconstruction nail just due to technique demanding purpose is very pity. We developed such technique to make patient with displaced ipsilateral femoral neck-shaft fractures treat by closed and one-step method and gained more satisfaction.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
