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Scientific Articles   |    
Clamp-Assisted Reduction of High Subtrochanteric Fractures of the Femur
Alan Afsari, MD1; Frank Liporace, MD2; Eric Lindvall, DO1; Anthony InfanteJr., DO1; Henry C. Sagi, MD1; George J. Haidukewych, MD1
1 Orthopedic Trauma Service, Florida Orthopedic Institute, 13020 Telecom Parkway, Temple Terrace, FL 33637. E-mail address for G.J. Haidukewych: DocGJH@aol.com
2 North Jersey Orthopaedic Institute, 90 Bergen Street, Suite 1200, Newark, NJ 07103
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (DePuy Trauma and Smith and Nephew). Also, commercial entities (Smith and Nephew, Stryker, and DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Orthopedic Trauma Service, Florida Orthopedic Institute, Tampa General Hospital, Tampa, Florida, and the Department of Orthopaedics, University of New Jersey, Newark, New Jersey

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):1913-1918. doi: 10.2106/JBJS.H.01563
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Abstract

Background: Subtrochanteric fractures can be a treatment challenge. The substantial forces that this region experiences and the fact that the proximal fragment is frequently displaced make accurate reduction and internal fixation difficult. The purpose of this study was to evaluate a series of patients who had undergone clamp-assisted reduction and intramedullary nail fixation to determine the impact of this technique on fracture union rates and reduction quality.

Methods: Between December 2003 and January 2007, fifty-five consecutive patients with a displaced high subtrochanteric femoral fracture were treated with clamp-assisted reduction and intramedullary nail fixation at two level-I trauma centers. Two patients died, and nine were lost to follow-up. The remaining forty-four patients were followed until union or a minimum of six months. There were twenty-seven male and seventeen female patients with a mean age of fifty-five years. All were treated with an antegrade statically locked nail implanted with a reaming technique as well as the assistance of a reduction clamp placed through a small lateral incision. Nine patients were treated with a single supplemental cerclage cable. Radiographs were evaluated for the quality of the reduction and fracture union.

Results: Forty-three of the forty-four fractures united. All reductions were within 5° of the anatomic position in both the frontal and the sagittal plane. Thirty-eight (86%) of the forty-four reductions were anatomic. Six fractures had a minor varus deformity of the proximal fragment (between 2° and 5°). There were no complications.

Discussion: Surgical treatment of subtrochanteric femoral fractures with clamp-assisted reduction and intramedullary nail fixation techniques with judicious use of a cerclage cable can result in excellent reductions and a high union rate. Careful attention to detail is important to perform these maneuvers with minimal additional soft-tissue disruption.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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