Functional outcome of intertrochanteric fractures in elderly patients with proximal femoral nail: retrospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192612Keywords:
Proximal femoral fractures, Proximal femoral nail, Internal fixation, ComplicationsAbstract
Background: Intertrochanteric fractures are disabling injuries in elderly population and they are the most frequently operated fracture type which has the highest postoperative fatality rate of all surgically treated fractures. The objective of the study was to evaluate the functional outcomes of intertrochanteric fractures treated with proximal femoral nail (PFN) in elderly patients.
Methods: A retrospective study of 24 patients, all above 60 years treated with PFN between March 2016 to April 2018. Data collected include age, sex, mechanism of injury, type of fracture pattern according to Boyd and Griffin’s classification. Patients were followed up at intervals of 6, 12, 18 and 24 weeks and final results were evaluated using Kyle’s criteria at the end of 24th week. All patients had a minimum follow up of one year.
Results: The study included 24 patients, 10 males, 14 females with mean age of 75.77 years (range: 60-82 years). The fracture union rate was 96% and average union time was 14.2 weeks. Our results were excellent (80%), good (8%), fair (8%) and poor (4%). Our complications include thigh pain (20%) shortening (20%), varus displacement (8%), knee and hip stiffness (8%), z effect (4%) and non-union (4%).
Conclusions: PFN is a reliable fixation in intertrochanteric fractures only after good intraoperative reduction leading to high rate of bone union and with reduced rate of implant failure or complications.
References
Evans PJ, McGrory BJ. Fractures of proximal femur. Hospital Physician. 2002;38:30-8.
Melton LJ 3rd, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, et al. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. 2009;20(5):687–94.
Hagino H, Furukawa K, Fujiwara S, Okano T, Katagiri H, Yamamoto K, et al. Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int. 2009;20(4):543–8.
Tornetta P III. Rockwood and Green’s fractures in adults. 8th ed. vol 2: 2014: 2076.
Falch JA, Liebekk A, Slungaard U. Epideomology of hip fractures in Norway. Acta Orthop Scand. 1986;56:12-6.
Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomized study comparing post-operative rehabilitation. J Bone Joint Surg Br. 2005;87:76-81.
Bonnaire F, Zenker H, Lill C, Weber AT, Linke B. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int. 2005;16(2):93-102.
Chou DT, Taylor AM, Boulton C, Moran CG. Reverse oblique intertrochanteric femoral fractures treated with the intramedullary hip screw (IMHS). Injury. 2012;43(6):817-21.
Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with proximal femoral nail. Int Orthop. 2001;25(5):298-301.
Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty two cases of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1979;61:216-21.
Cooper C. the crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103(2):12-7.
Curtis MJ, Jinnah RH, Wilson V, Cunningham BW. Proximal femoral fractures: A biomechanical study to compare intramedullary and extramedullary fixation. Injury. 199425:99-104.
Pavelka T, Houcek P, Linhart M, Matejka J. Osteosynthesis of hip and femoral shaft fractures using the PFN-long. Acta Chir Orthop Traumatol Cech. 2007;74:91-8.
Barquet A, Francescoli L, Rienzi D, Lopez L. Intertrochanteric- subtrochanteric fractures: treatment with the long Gamma nail. J Orthop Trauma. 2000;14:324-8.
Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma. 2005;19:656-60.
Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062–72.
Bischoff-Ferrari HA, Giovannucci E, Willett WC. Estimation of optimal serum concentration of 25 hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84(1):18-28.
Broe KE, Chen TC, Weinberg J, et al. A higher dose of vitamin d reduces the risk of falls in nursing home residents: A randomized, multiple-dose study. J Am Geriatr Soc. 2007;55(2):234–9.