Kook Incheol, Gil Young Woon, Hwang Kyu Tae
Department of Orthopedic Surgery, Nowon Eulji Medical Center, Seoul, Korea.
Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea.
Clin Orthop Surg. 2025 Apr;17(2):194-203. doi: 10.4055/cios24271. Epub 2025 Mar 14.
Varus malalignment is a risk factor for nonunion and mechanical complications in subtrochanteric femoral fractures (SFFs). Although various reduction techniques have been reported to avoid varus malalignment in SFFs, achieving anatomic reduction remains challenging, often resulting in residual varus alignment (RVA) after reduction. This study aimed to investigate the radiographic and clinical outcomes of a novel method resolving RVA by abducting the ipsilateral hip after cephalomedullary fixation with an intramedullary nail and subsequently inserting distal interlocking screws.
This retrospective study, conducted between March 2016 and March 2022, included patients who underwent hip abduction during intramedullary nailing due to RVA. Demographics and fracture patterns (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA]) and types (typical or atypical) were analyzed. Radiographic outcomes included Baumgaertner reduction quality criteria (BRQC), tip-apex distance (TAD), neck-shaft angle (NSA), lateral cortex residual gap, union, and time to union. Clinical outcomes included ambulatory level using the Palmer-Parker Mobility Score (PPM), complications, and reoperation.
This study included 45 patients (mean age, 65.8 years; mean follow-up period, 18.4 months). The most common fracture pattern was 32A2 in 15 patients and 29 were typical and 16 were atypical fractures. The BRQC was good in 36 patients, and TAD was < 25 mm in 43 patients. Pre-abduction NSA (126.0° ± 3.8°) was significantly smaller than post-abduction NSA (129.9° ± 3.4°, < 0.001). Post-abduction NSA was comparable to contralateral NSA of 128.9° ± 2.8° ( = 0.155). Residual gap was significantly reduced from 6.1 ± 2.9 mm pre-abduction to 1.7 ± 1.0 mm post-abduction ( < 0.001). Union was achieved in 44 patients (97.8%; mean duration, 5.9 months). PPM decreased from 7.8 ± 2.0 pre-injury to 7.0 ± 2.1 1-year postoperatively. One nonunion case required reoperation. Radiographic outcomes did not significantly differ by fracture pattern ( = 0.470 for NSA and = 0.334 for residual gap).
Hip abduction during intramedullary nailing corrects alignment and reduces the gap in SFFs with residual varus alignment. This method can be applied to various fracture patterns in a straightforward manner and considered valuable for managing SFFs.
内翻畸形是股骨转子下骨折（SFFs）不愈合和机械并发症的危险因素。尽管已有多种复位技术报道可避免SFFs出现内翻畸形，但实现解剖复位仍具有挑战性，复位后常导致残余内翻畸形（RVA）。本研究旨在探讨一种新方法的影像学和临床疗效，该方法是在使用髓内钉进行头髓内固定后外展同侧髋关节，随后插入远端交锁螺钉来解决RVA。
本回顾性研究在2016年3月至2022年3月期间进行，纳入因RVA在髓内钉固定期间进行髋关节外展的患者。分析人口统计学资料、骨折类型（ Arbeitsgemeinschaft fur Osteosynthesefragen/骨科创伤协会[AO/OTA]）和类型（典型或非典型）。影像学结果包括鲍姆加特纳复位质量标准（BRQC）、尖顶距（TAD）、颈干角（NSA）、外侧皮质残余间隙、愈合情况及愈合时间。临床结果包括使用帕尔默 - 帕克活动评分（PPM）评估的活动水平、并发症及再次手术情况。
本研究纳入45例患者（平均年龄65.8岁；平均随访期18.4个月）。最常见的骨折类型是15例患者为32A2型，29例为典型骨折，16例为非典型骨折。36例患者BRQC良好，43例患者TAD＜25 mm。外展前NSA（126.0°±3.8°）显著小于外展后NSA（129.9°±3.4°，P＜0.001）。外展后NSA与对侧NSA的128.9°±2.8°相当（P = 0.155）。残余间隙从外展前的6.1±2.9 mm显著减小至外展后的1.7±1.0 mm（P＜0.001）。44例患者（97.8%）实现愈合（平均持续时间5.9个月）。PPM从伤前的7.8±2.0降至术后1年的7.0±2.1。1例不愈合病例需要再次手术。影像学结果在骨折类型之间无显著差异（NSA的P = 0.470，残余间隙的P = 0.334）。
髓内钉固定期间进行髋关节外展可纠正SFFs伴残余内翻畸形的对线并减小间隙。该方法可直接应用于各种骨折类型，并被认为对SFFs的治疗具有重要价值。
