Evaluation of outcome following clamp assisted mini open reduction and internal fixation with intramedullary nailing of subtrochanteric femoral fractures
Keywords:Clamp assisted reduction, Minimally open procedure, Subtrochanteric femur fracture
Background: Subtrochanteric fractures of the proximal femur have been defined as the fractures extending from lesser trochanter distally for 5 cm. These fractures usually occur in two age distributions. In the elderly osteopenic population resulting from trivial trauma as fall from standing height or in the younger ones as a result of high energy trauma. Incidence has been on the rise and they comprise about 7 to 10% hip fractures and could lead quickly to large amount of blood loss and other complications.
Methods: This is a multicentric prospective prognostic study level 1 consisting of 25 patients admitted in government civil hospital, Ahmedabad during April 2013 to May 2015 having high subtrochanteric femur fractures treated by clamp assisted reduction and intramedullary nailing. Out of these, 20 patients (80%) came for final follow up with average follow up of 11.5 months and evaluated for union, complication and functional outcome.
Results: In our study final outcome is assessed based on hip outcome score (modified) based on which 85% had excellent outcome, 10% had good outcome and 5% had fair outcome with none of the patient having poor outcome.
Conclusions: We found that clamp-assisted reduction and intramedullary nail fixation provides excellent reduction quality, high rate of fracture union, with no apparent increase in complications in subtrochanteric fractures of the femur.
De Lee JC, Clanton TO, Rockwood CA Jr. Closed treatment of subtrochanteric fractures of the femur in a modified cast-brace. J Bone Joint Surg Am. 1981;63:773-9.
Koch JC. The laws of Bone architecture. Am J Anat. 1917;2:177.
Canale ST, Beaty JH. Campbell’s operative orthopaedics. 12th edition. Volume 3. Elsevier; 2013: 2751-2752.
Haidukewych GJ, Berry DJ. Non-union of fractures of the subtrochanteric region of the femur. Clin Orthop Relat Res. 2004;419:185-8.
Broos PL, Reynders P. The use of the unreamed AO femoral in¬tramedullary nail with spiral blade in non-pathologic fractures of the femur- experiences with eighty consecutive cases. J Orthop Trauma. 2002;16:150-4.
Blatter G, Janssen M. Treatment of subtrochanteric fractures of the femur- reduction on the traction table and fixation with dy¬namic condylar screw. Arch Orthop Trauma Surg. 1994;113:138- 41.
Hotz TK, Zelweger R, Kach KP. Minimal invasive treatment of proximal femur fractures with the long gamma nail- indication, technique, results. J Trauma. 1999;47:942-5.
Tornetta P. Subtrochanteric femur fracture. J Orthop Trauma. 2002;16:280-3.
Siebenrock KA, Muller U, Ganz R. Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric frac¬tures. Injury. 1998;29(3):7-15.
Ruff ME, Lubbers LM. Treatment of subtrochanteric fractures with a sliding screw-plate device. J Trauma. 1986;26:75-80.
Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Ambu¬latory ability after hip fracture. A prospective study on geriatric patients. Clin Orthop Relat Res.1995;310:150-9.
Roberto U, Velasco MD, Thomas HC. Analy¬sis of treatment problems in sub-trochanteric fractures of the fe¬mur. J Trauma. 1978;18:513–23.
Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Jt Surg. 1978;60-A:300-6.
Lunsjo K, Ceder L, Thorngren KG, Skytting B, Tidermark J, Burntson PO. Extramedullary fixation of 569 unstable intertro¬chanteric fractures. Acta Orthop Scand. 2001;72:133-40.
Brien WW, Weiss DA, Becker V, Lehman T. Subtrochanteric femur fractures- a comparison of the Zickel nail, 95-degree blade plate and interlocking nail. J Orthop Trauma. 1991;5:458-64.
Christian B, Franz JS, Florian F. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures. Acta Orthop Scand. 2003;74(1):53-8
Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures? Clin Orthop Relat Res. 2005;439:221–7.
Manzoor AH, Shabir AD, Mohammed IW, Mohammed FB. The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results? Strategies Trauma Limb Reconstr. 2007;2(2):77-81.
Tahir D, Arshad B, Abdul RB, Muzaffar G. Complications of treatment of the subtrochanteric fractures of the femur by russell-taylor reconstruction nail. Internet J Orthop Surg. 2008;12(1):1-4.
Schipper B. Treatment of Unstable trochanteric fractures. JBJS. 2004;86 B:86–94.
Subramanyam Y. A study of management of subtrochanteric fracture femur by proximal femoral nailing. Dissertation. 2011:1-85.