Outcome of cephalo-medullary nailing in intertrochanteric fracture of femur
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20220368Keywords:
Cephalomedullary nail, Intertrochanteric fracture, Femur, Modified Harris hip scoreAbstract
Background: Intertrochanteric fracture is commonly seen in elderly and osteoporotic bone due to trivial trauma and requires hospitalization. Nonoperative treatment leads to complications like bedsore, pneumonia and deep vein thrombosis. The introduction of cephalomedullary nailing has broadened its use in complex intertrochanteric fracture with least complications.
Methods: A prospective observational study was conducted in Birgunj, Nepal from 4th October 2020 to 3rd October 2021 among 50 patients of age more than 30 years with closed intertrochanteric fractures. Ethical approval was obtained from the institutional review committee and proper informed consent was taken. Modified Harris hip scoring system was used. Type of implant used was PFN long and short.
Results: The mean age of 50 patients was 66.42 years, female to male ratio was 1.5:1 (30:20) and right side (72%) with fall injury (78%) was commonly observed. According to Kyles classification, 40% patients had Kyles’s type II fracture followed by type III (38%). Most of the cases start mobilization on 2nd post operative day. Mean Harris hip score at 14 days, 6 weeks, 3 months and 6 months were 52.02, 64.50, 72.91 and 84.40 respectively. Early mobilization within 2 days of post-surgery had significant improvement in functional outcome throughout follow up as compared to more than 2 days (p=0.001, 0.001, 0.001 and 0.001 at 14 days, 6 weeks, 3 months and 6 months respectively). Radiological union was achieved in all cases within 6 months.
Conclusions: The study results concluded cephalomedullary nailing is effective treatment for intertrochanteric fracture.
References
Dimon JH, Hughston JC. Unstable intertrochanteric fractures of the hip. J Bone Joint Surg Am. 1967;49(3):440-50.
Campbell WC, Canale ST, Beaty JH. Campbell’s operative orthopaedics. 14th ed. Philadelphia, PA: Mosby/Elsevier. 2020.
Rockwood CA, Green DP, Bucholz RW. Rockwood and Green’s fractures in adults. 9th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams and Wilkins. 2019.
Kenzora JE, Mccarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Related Res. 1984(186):45-56.
Mao-qi G, Yu-jiang M, Jie W, Man-Yi W, Jie B, Qiao-ling F et al. Outcome of hip fractures after traction treatment in elderly. Zhonghua Yi Xue Za Zhi. 2005;85(46):3263-5.
Magyar G, Toksvig-Larsen S, Moroni A. Hydroxyapatite coating of threaded pins enhances fixation. J Bone Joint Surg Br. 1997;79(3):487-9.
Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Academy Orthop Surg. 2008;16(10):596-607.
Fung W, Jönsson A, Bühren V, Bhandari M. Classifying intertrochanteric fractures of the proximal femur: does experience matter? Med Principles Practice. 2007;16(3):198-202.
Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Academy Orthop Surg. 2008;16(11):665-73.
Morris AH, Zuckerman JD, American Academy of Orthopaedic Surgeons Council of Health Policy and Practice. National Consensus Conference on Improving the Continuum of Care for Patients with Hip Fracture. J Bone Joint Surg Am. 2002;84:670-4.
Jonnes C, Shishir S, Najimudeen S. Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Arch Bone Joint Surg. 2016;4(1):23.
Wu Y, Watson JT, Kuldjanov D, Jackman J. Rotationally stable fixation for intertrochanteric hip fractures: the Intertan experience, surgical technique, and outcomes. Tech Orthop. 2014;29(3):120-32.
Gadegone Wasudeo M, Salphale Yogesh S. Short proximal femoral nail fixation for trochanteric fractures. J Orthop Surg. 2010;18(1):39-44.
Terry Canale S, James H Beaty, Campbell‘s Operative orthopaedics, Elsevier, 13th edition. 2017;3239.
Korkmaz MF, Erdem MN, Disli Z, Selcuk EB, Karakaplan M, Gogus A. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases. Clin Interventions aging. 2014;9:569.
Li M, Wu L, Liu Y, Wang C. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures. J Orthop Surg Res. 2014;9(1):112.
Gadegone WM, Salphale YS. Short proximal femoral nail fixation for trochanteric fractures. J Orthop Surg. 2010;18(1):39-44.
Novack V, Jotkowitz A, Etzion O, Porath AV. Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Quality Health Care. 2007;19(3):170-6.
Kale A, Munde D, Mangukiya HJ, Waghmare V. A comparative study of long versus short proximal femoral nail in peritrochanteric and subtrochanteric fractures in adults. Int J Orthop. 2018;4(2):717-21.
Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthopaedica Scandinavica. 2003;74(1):53-8.
Kawatani Y, Nishida K, Anraku Y, Kunitake K, Tsutsumi Y. Clinical results of trochanteric fractures treated with the TARGON® proximal femur intramedullary nailing fixation system. Injury. 2011;42:S22-7.
Sui AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS. Early ambulation after hip fracture. Arch Intern Med. 2006;166:766-71.
Vishwanathan K, Akbari K, Patel AJ. Is the modified Harris hip score valid and responsive instrument for outcome assessment in the Indian population with pertrochanteric fractures? J Orthop. 2018;15(1):40-6.
Asad KG, Syed KAS, Muhammad AK, Muhammad AG, Muhammad KRN. Role of Proximal Femoral Nail in the Treatment of Unstable Intertrochanteric Fractures. Biomed J Sci Tech Res. 2018;2(1):000645.
Uzun M, Ertürer E, Ozturk I, Akman S, Seçkin F. Longterm radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc. 2009;43(6):457-63.
Yadkikar S, Yadkikar V, Prasad D, Marawar A. Prospective study of proximal femoral nail in management of trochanteric and subtrochanteric fractures of femur. Int J Biomed Adv Res. 2015;6(4):349-54.
Rethnam U, Cordell-Smith J, Kumar TM, Sinha A. Complex proximal femoral fractures in the elderly managed by reconstruction nailing-complications and outcomes: a retrospective analysis. J Trauma Management Outcomes. 2007;1(1):7.