title: Intramedullary fixation of subtrochanteric fractures with the Williams Y-nail: report of three cases.
abstract: Küntscher Y-nailing is indicated for unstable proximal fractures of the femur in the elderly (5-7,10). The Williams modified Y-nail is an interlocking Y-nail that was designed to extend the indications beyond those of the Küntscher Y-nail. The Williams Y-nail was employed in three cases of subtrochanteric and subtrochanteric-intertrochanteric fractures, including one case in which there was an ipsilateral femoral shaft fracture. This procedure requires reaming and interlocking which are not performed in classic Küntscher Y-nailing. At follow-up (14-month minimum), each patient had a good clinical result and radiographic healing. Leg length shortening (maximum, 1.5 cm) occurred in two of three cases, primarily as a result of the failure to employ either a proximal or a distal interlocking screw. No other deformities have been observed. Williams Y-nailing can extend the indications of the Küntscher Y-nail to include rotationally unstable subtrochanteric fractures and associated ipsilateral femoral shaft fractures. The increased technical demands of the Williams modified Y-nail warrant cautious use depending upon the complexity of the fracture. Used properly, the Williams Y-nail may reduce the incidence of rotational and leg length deformities often experienced with other commonly used devices for unstable subtrochanteric and ipsilateral trochanteric-diaphyseal fractures of the femur.
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville School of Medicine, Kentucky 40292.
authors.forename: S L
authors.initials: SL
authors.lastname: Henry
authors.forename: J
authors.initials: J
authors.lastname: Werner
authors.forename: D
authors.initials: D
authors.lastname: Seligson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D008875:Middle Aged