Skip to main content
SpringerLink
Log in

Use of blocking screws in intramedullary fixation of subtrochanteric fractures

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Intramedullary fixation is the mainstay of treatment for femur fractures in the adult trauma population. With subtrochanteric fractures, accurate reduction and stable fixation become technically challenging. Adjuvant blocking screws in the proximal fragment can effectively be used to prevent varus and apex anterior malalignment when intramedullary nails are used in these fractures. Blocking screws decrease the canal volume, thereby allowing the intramedullary device to control the proximal segment. This aids in improving alignment between the proximal and distal fragments during reduction. We review the cases of six patients with proximal femur fractures who were treated with intramedullary nailing in conjunction with the placement of blocking screws.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP (2007) Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 38:1286–1293. doi:10.1016/j.injury.2007.05.013

    Article  PubMed  Google Scholar 

  2. Craig NJ, Sivaji C, Maffulli N (2001) Subtrochanteric fractures. A review of treatment options. Bull Hosp Jt Dis 60: 35–46. PMID:11759576

    Google Scholar 

  3. Parker MJ, Handoll HHG (2010) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev9:CD000093. pub 5. doi:10.1002/14651858.CD000093.pub5

  4. Floyd JC, O’Toole RV, Stall A, Forward DP, Nabili M, Shillingburg D, Hsieh A, Nascone JW (2009) Biomechanical comparison of proximal locking plates and blade plates for the treatment of comminuted subtrochanteric femoral fractures. J Orthop Trauma 23:628–633. doi:10.1097/BOT.0b013e3181b04835

    Article  PubMed  Google Scholar 

  5. Nikolaou VS, Papathanasopoulos A, Giannoudis PV (2008) What’s new in the management of proximal femoral fractures. Injury 39:1309–1318. doi:10.1016/j.injury.2008.09.001

    Article  PubMed  CAS  Google Scholar 

  6. Sims SH (2002) Subtrochanteric femur fractures. Orthop Clin North Am 33:113–126, viii. PMID:11832316. doi:10.1016/S0030-5898%2803%2900075-0

    Google Scholar 

  7. Celebi L, Can M, Muratli HH, Yagmurlu MF, Yuksel HY, Bicimoğlu A (2006) Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury 37:740–750. doi:10.1016/j.injury.2005.12.022

    Article  PubMed  CAS  Google Scholar 

  8. Lee PC, Hsieh PH, Yu SW, Shiao CW, Kao HK, Wu CC (2007) Biologic plating versus intramedullary nailing for comminuted subtrochanteric fractures in young adults: a prospective, randomized study of 66 cases. J Trauma 63:1283–1291. doi:10.1097/TA.0b013e3180f62f00

    Article  PubMed  Google Scholar 

  9. Rahme DM, Harris IA (2007) Intramedullary nailing versus fixed angle blade plating for subtrochanteric femoral fractures: a prospective randomised controlled trial. J Orthop Surg (Hong Kong) 15:278–281. PMID:18162669

    Google Scholar 

  10. Ekström W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts KA (2007) Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma 21:18–25. doi:10.1097/BOT.0b013e31802b41cf

    Article  PubMed  Google Scholar 

  11. Saarenpää I, Heikkinen T, Jalovaara P (2007) Treatment of subtrochanteric fractures. A comparison of the Gamma nail and the dynamic hip screw: short-term outcome in 58 patients. Int Orthop 31:65–70. doi:10.1007/s00264-006-0088-9

    Google Scholar 

  12. Vaidya SV, Dholakia DB, Chatterjee A (2003) The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Injury 34:123–128. doi:10.1016/S0020-1383(02)00319-4

    Article  PubMed  Google Scholar 

  13. Roberts CS, Nawab A, Wang M, Voor MJ, Seligson D (2002) Second generation intramedullary nailing of subtrochanteric femur fractures: a biomechanical study of fracture site motion. J Orthop Trauma 16:231–238. PMID:11927803. Accession: 00005131-200204000-00003

    Google Scholar 

  14. Ricci WM, Bellabarba C, Lewis R, Evanoff B, Herscovici D, Dipasquale T, Sanders R (2001) Angular malalignment after intramedullary nailing of femoral shaft fractures. J Orthop Trauma 15:90–95. PMID:11232660. Accession: 00005131-200102000-00003

    Google Scholar 

  15. Donald G, Seligson D (1983) Treatment of tibial shaft fractures by percutaneous Küntscher nailing. Technical difficulties and a review of 50 consecutive cases. Clin Orthop Relat Res 178:64–73

    PubMed  Google Scholar 

  16. Krettek C, Miclau T, Schandelmaier P, Stephan C, Möhlmann U, Tscherne H (1999) The mechanical effect of blocking screws (‘‘Poller screws’’) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma 13:550–553. Accession: 00005131-199911000-00006

    Google Scholar 

  17. Stedtfeld HW, Mittlmeier T, Landgraf P, Ewert A (2004) The logic and clinical applications of blocking screws. Bone Joint Surg Am 86(suppl 2):17–25. Accession: 00004623-200412002-00004. PMID:15691104

    Google Scholar 

  18. Siebenrock KA, Müller U, Ganz R (1998) Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury 29:C7–C15. PMID:10341892

    Google Scholar 

  19. Herscovici D Jr, Pistel WL, Sanders RW (2000) Evaluation and treatment of high subtrochanteric femur fracture. Am J Orthop (Belle Mead NJ) 29(9 suppl):27–33. PMID:11011777

    Google Scholar 

  20. Alho A, Strømsøe K, Ekeland A (1991) Locked intramedullary nailing of femoral shaft fractures. J Trauma 31:49–59. PMID:1986133

    Google Scholar 

Download references

Acknowledgment

The authors would like to acknowledge the assistance of Ms. Diana Winters in the preparation and submission of the manuscript.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, 19102, USA

    Nirav H. Amin, Anna Katsman, Rajit Chakravarty, Susan Harding & Douglas L. Cerynik

Authors
  1. Nirav H. Amin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Katsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajit Chakravarty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Harding
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas L. Cerynik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas L. Cerynik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Amin, N.H., Katsman, A., Chakravarty, R. et al. Use of blocking screws in intramedullary fixation of subtrochanteric fractures. Eur J Orthop Surg Traumatol 22, 703–707 (2012). https://doi.org/10.1007/s00590-011-0898-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-011-0898-3

Keywords

Search

Navigation