OSTEOSYNTHESIS OF SUBTROCHANTERIC FRACTURES USING PROXIMAL FEMORAL NAIL: A PROSPECTIVE STUDY
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2018, Vol 4, Issue 2
Abstract
Background Subtrochanteric fractures remain one of the most challenging fractures to be treated by orthopaedic surgeons. The most appropriate implant for internal fixation of subtrochanteric fractures remains a subject of debate, and many different intramedullary and extramedullary implants have been advocated for surgical fixation of these fractures. Due to better understanding of biology, reduction techniques and biomechanically improved implants like Gamma nail, Russell Taylor nail, Proximal femoral nail(PFN), results have shown consistent improvement in the post operative outcome. The purpose of this paper is to share our observations with intramedullary fixation of subtrochanteric fractures with proximal femoral nail at a secondary health care level. Material and Methods The prospective study included 22 patients with fresh subtrochanteric fractures admitted in our hospital who underwent an intramedullary fixation with PFN. Patients with pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Results In our study of 22 patients, there were 19 male and 3 female patients with mean age of 38.25 years (range 18-70 years). 68.2% of the patients (n=15) had fractures due to road traffic accidents, 22.8 % (n= 5) patients due to fall from height and 10% of the patients (n=2) due to trivial fall with right side being more common side affected. Time to radiological union ranged between 4 months to 9 months (mean 6.2month). Two patients got malunion with one patient having 150 varus and other had 100 retroversion respectively. One patient developed breakage of superior 6mm screw being longer than the 8mm screw; but the fracture united uneventfully. Two patients got shortening of less than 1.5cm. One patient got superficial wound infection which responded to oral antibiotics. As per Harris Hip score, excellent results were noted in 36.36% cases, good in 54.54% cases and fair in 9% cases. Conclusion PFN is a viable treatment option for subtrochanteric fractures with high rate of fracture union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.
Authors and Affiliations
Nisar Ahmad Dar, Nissar Ahmad Shah, Muhammad Bin A Hamid, Ilyas Ahmad Shah
Keywords
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