제한적 관혈적 정복 및 교합성 골수내정 고정술을 이용한 대퇴골 근위 간부 골절의 치료

Abstract

Introduction: The difficulty of treating proximal femoral shaft fracture with intramedullary nailing is choosing the appropriate portal for insertion and fracture reduction. This could cause newly developed fractures or deformation. The clinical outcome and complication for treating proximal femoral shaft fracture were compared and analyzed through the group treated with closed intramedullary nailing and the group treated with limited open reduction and intramedullary nailing technique where proximal femoral shaft fractures were difficult to manage with closed reduction. Materials and Methods: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture including cases where the fracture line was extended to the intertrochanter line and were available for follow-up for more than 12 months were selected between March 2001 and December 2005. Fourteen patients were male and 1 patient was female. The mean age was 41.2 years (19-70). The causes of injury were traffic accident in 10 cases, fall down in 5 cases and 11 cases had combined injury including fractures of the pelvis, lower extremity, hand, abdomen and brain injury. According to Winquist-Hansen classification, 5 cases were type I, 2 cases were type II, 3 cases were type III and 5 cases were type IV. Simple proximal shaft or subtrochanteric fracture was observed in 7 cases, fracture extending from the proximal shaft to the subtrochanter was observed in 5 cases, proximal segmental fracture in 2 cases and combined distal shaft fracture in 1 case. The mean period between injury to operation was 7.2days (0-16). All operations were done in a supine position with intramedullary nailing with opening limited to the fracture site. Results: Postoperative bone union was evaluated by loss of pain, the ability to ambulate under full weight bearing, loss of fracture line in simple radiographic picture and formation of callus. Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14-32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft. Conclusion: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing can help find the appropriate insertion portal and enable satisfying reduction. Limited open reduction and intramedullary nailing cannot be indicated in the cases which reduction can be made with closed reduction as the risk of bleeding and infection is high, but it seems to be an efficient technique to manage proximal femoral shaft fracture that has combined fracture or is unable to acquire acceptable reduction.