Purpose: This study was designed to compare the clinical and radiological results of intramedullary fixation to those of extramedullary fixation in patients with reverse oblique or transverse intertrochanteric femoral fractures.
Materials and Methods: We retrospectively reviewed 39 cases of reverse oblique or transverse intertrochanteric femoral fractures between September 2001 and December 2010. There were 20 cases treated with intramedullary fixation (Group I) and 19 cases treated with extramedullary fixation (Group II). The operative time, intraoperative blood loss, amount of blood transfused, hospital day, and time to bone union were compared between the two groups. Radiologically, the position and sliding length of the lag screw or blade, change of femoral neck-shaft angle, and medialization of distal fragment were compared. Also, complications were assessed.
Results: The mean operative time was 87.8 minutes with Group I and 153.8 minutes with Group II. The mean intraoperative blood loss was 375.0 ml with Group I and 1,015.8 ml with Group II. The mean amount of transfusion was 555.5 ml with Group I and 801.6 ml with Group II. The mean time to bone union was 12.1 weeks with Group I and 18.1 weeks with Group II. There were no statistical differences in other parameters between the two groups.
Conclusion: The intramedullary fixation group revealed better results in the aspects of invasiveness and time to bone union in comparison with the extramedullary fixation group for the treatment of reverse oblique or transverse intertrochanteric femoral fractures.

Purpose: To investigate the clinical and radiologic outcome after treatment of intertrochanteric fractures of femur using targon proximal femoral nails (PFN).
Materials and Methods: One hundred fifty-five cases of intertrochanteric fracture who were treated with targon PFN from August 2004 to June 2010 were included. There were 54 men and 101 women with a mean age of 74.1 years at the time of surgery. There were 97 cases of stable fracture and 58 cases of unstable fracture. Operation time, frequency of transfusion, weight-bearing time, ability of activity after operation, and complications were all clinically investigated. Also, the average sliding of a lag screw and average union period were radiologically investigated.
Results: The average operation time was 64 minutes and transfusion was required in 43 cases(27%). The average weight bearing time was 4.4 days. In 96 cases(62%), the pre-injury activity level was recovered. The average slide of the lag screw was 5.6 mm and the average union period was 10 weeks. There were 6 cases (3.8%) of complications including 3 cases antirotation pin cutout and 3 cases of periprosthetic fracture.
Conclusion: The treatment of intertrochanteric fractures using targon PFNs showed a satisfactory clinical outcome and a lower radiological complication rate.

Purpose: The purpose of this study is to evaluate the outcome after operative treatment with plate fixation in Vancouver B1 and C periprosthetic unstable femoral fractures.
Materials and Methods: We conducted a retrospective assessment of 15 patients who had under gone treatment for a periprosthetic unstable femoral fracture around primary hip arthroplasty between April 1997 and July 2010. The mean age of patients was 69 years(53 to 82 years) at the time of surgery and the mean duration of follow-up was 29.2 months (six to 110 months). According to Vancouver classification, 10 patients were type B1 and five were type C. According to the time of operation, open reduction and internal fixation was performed using four different plates. Bone graft was applied in all patients, regardless of the type of plate. The present review describes the clinical and radiographic results.
Results: All patients were able to ambulate without assistance of crutches or walkers. Of the 15 patients, the fracture site was united in all patients. Postoperative dislocation of the ipsilateral hip was observed in one patient; however, there was no occurrence of further complications, such as infections, nerve injuries, or loosening of the femoral stems.
Conclusion: In Vancouver type B1 and C fractures, without any loosening of the femoral stems, open reduction with plate fixation using our operative methods provided a satisfactory result.

The incidence of femoral head fracturesafter posteriorhip dislocation is approximately 5-15%, and femoral head fractures are highly associated with posterior dislocation. Femoral head fractures can cause avascular necrosis of the femoral head or post-traumatic osteoarthritis; therefore, diagnosis and appropriate treatment is important. We present a case of femoral head fracture without hip dislocation, as well as a literature review.

Purpose: The aim of this study was to identify the causes of fixation failure and evaluate prophylactic methods in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation.
Materials and Methods: Between 2006 and 2010, this study evaluated 80 cases(20 men and 60 women) of femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation after a minimum follow-up of 1 year. The mean age and follow-up period was 72.6 years and 2.1 years, respectively. The factors that could affect fixation failure, such as osteoporosis, fracture pattern, reduction status and position of helical blade on the femoral head, were analyzed retrospectively.
Results: Six cases of fixation failure were encountered: 4 cases of cut out of the helical blade, 1 case of excessive varus union and 1 case of hip joint pain due to the excessive sliding of helical blade. The reduction status and position of the helical blade on the femoral head showed a significant association with the fixation failure, and there were 2 cases of osteonecrosis of the femoral head at the latest follow-up.
Conclusion: Fixation failure was increased significantly in the case of non-anatomical reduction or superior position of helical blade in the femoral head. Therefore, the concerns related to the precise anatomical reduction and central location of the helical blade will need to be solved to reduce fixation failure.

Purpose: The purpose of this study is to analyze the clinical and radiographic results of treatment of unstable pertrochanteric hip fractures in which the fracture line is extended distally or the width of the canal is wide using a long intramedullary nail.
Materials and Methods: From January 2005 to January 2010, we conducted an analysis of 20 cases of unstable pertrochanteric hip fractures (over AO/OTA 31 A2.2) treated using a long intramedullary nailing and followed up for more than 12 months. Using postoperative and last follow-up radiographs, we measured TAD, Cleveland index, neck-shaft angle, sliding length of the lag screw, and union time. Clinically, we measured the operation time, the amount of transfusion, and Parker and Palmer’s mobility score.
Results: The mean bony union time was 16.4 weeks(10-21 weeks). The mean sliding length of the lag screw was 4.3 mm(1-10 mm) and the mean varus angulation after surgery was 5.1°(3-8°). The mean operative time was 118 min(60-140 min), and the mean transfusion amount was 2.0 pint(0-4 pint). According to Parker and Palmer’s mobility score, mean preoperative score was 7.5 points and mean postoperative score at last follow-up was 6.9 points.
Conclusion: In treatment of unstable pertrochanteric hip fractures, when the fracture line was extended to below the lesser trochanteric level or the medullary canal width was wide, use of a long intramedullary nail showed excellent clinical and radiologic results and can be regarded as a good treatment option.

Purpose: The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail.
Materials and Methods: From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed.
Results: In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw.
Conclusion: Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.

A non-traumatic, incomplete insufficiency fracture commonly involves the lateral side of the femoral cortex; whereas a non-traumatic, incomplete stress fracture commonly involves the medial side of the femoral cortex. Here, we describe a case of a 66-year-old woman with a two-month history of bilateral thigh pain without trauma or medication usage who was diagnosed with bilateral subtrochanteric insufficiency fractures involving the medial side of the femoral cortex.

Purpose: The purpose of this study is to evaluate the efficacy of the trochanter reattachment device (TRD) as a firm internal fixation method for bipolar hemiarthroplasty in unstable intertrochanteric femur fracture for elderly patients over 65 years old.
Materials and Methods: From September 2010 to April 2011, 19 patients (M/F: 1/18) over 65 years old were treated with bipolar hemiarthroplasty using the TRD as a fixation method for intertrochanteric femur fracture with above Evans-Jensen classification 2nd (above AO/OTA A1.3). They were followed up for more than 12 months(12-29 months).
Results: Out of 19 patients, only one had loosening of the TRD plate and reoperation was performed. There was no dislocation after surgery. Complete fracture union was observed in 19 patients with follow up of more than 12 months.
Conclusion: In bipolar hemiarthroplasty for intertrochanteric femur fracture, TRD produced easy and firm fixation. Additional fixation with TRD restoring abduction force by union of greater trochanter can be a good choice of surgery for avoidance of dislocation and chronic pain due to trochanteric nonunion after arthroplasty.

Purpose: The purpose of this study was to compare the outcomes of osteosynthesis using compression hip screw fixation versus bipolar hemiarthroplasty in AO type A2 intertrochanteric fractures.
Materials and Methods: From March 2003 to December 2009, 89 patients were included in this study. They were treated using compression hip screws (43 cases) or bipolar hemiarthroplasty (46 cases). The mean age of patients was 77.7 years (65-94 years) and the mean follow-up period was 5.9 years (1-8.3 years). For comparison of the outcomes in the two groups, statistical analyses were performed with parameters including anesthesia time, operation time, amount of transfusion, hospital stay, general complications, clinical outcome, time of partial weight-bearing using a walker, and radiological failure rate.
Results: Differences in the amount of transfusion, general complications, and clinical outcome (Merle d’Aubigné and Postel score) were not statistically significant between the two groups. The bipolar hemiarthroplasty group showed better results than the compression hip screw group for anesthesia time and the time of partial weight-bearing using a walker. Radiological failures were observed in hips in one case (2.2%) of bipolar hemiarthroplasty, and in four cases (9.3%) of compression hip screw fixation.
Conclusion: Among elderly individuals with AO type A2 intertrochanteric fractures, patients treated with bipolar hemiarthroplasty were able to perform early ambulation. However, no significant difference in operation time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between the bipolar hemiarthroplasty and compression hip screw fixation groups.