Unstable trochanteric fractures treated with proximal femoral nail show functional outcomes independent of the fracture type

Authors

  • Sourav Bhattacharjee Department of Orthopedics, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
  • Ashir Abdul Rasheed Department of Orthopedics, LFHRC, Kochi, Kerala, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241113

Keywords:

Functional outcome, Harris hip score, Proximal femoral nail, Trochanteric fracture

Abstract

Background: The proximal femoral nail has replaced the sliding hip screw devices and gamma nails as the implant of choice for unstable trochanteric fracture (AO 31A2-A3). In our study we aimed to find a correlation between fracture type, time taken for radiographic union and their functional outcome according to Harris Hip score at 6 months after PFN fixation of such fractures.

Methods: We assessed 38 patients sustaining unstable (AO 31A2-A3) trochanteric fractures. All the fractures were treated with short PFN. Functional outcome was assessed according to the HHS at sixth month follow-up.

Results: No statistically significant association was found between HHS with fracture type (p=0.184) and bone union time (p=0.587). The association between bone union time and fracture type was found to be statistically significant (p=0.007).

Conclusions: Functional outcome (HHS) does not depend upon the fracture type.

References

Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018; 19(1):369.

Charles RA, Green DP, Bucholz RW. Rockwood and Green's Fractures in Adults. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2015:2080.

Hedlund R, Lindgren U, Ahlbom A. Age- and sex-specific incidence of femoral neck and trochanteric fractures. An analysis based on 20,538 fractures in Stockholm County, Sweden, 1972-1981. Clin Orthop Relat Res. 1987;222:132-9.

Clawson DK. Trochanteric fractures treated by the sliding screw plate fixation method. J Trauma. 1964;4:737-52.

Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br. 1992;74(3):340-4.

Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury. 1995;26(9):615-8.

Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30(5):327-32.

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 Orthop Scand. 2003;74(1):53-8.

Al-yassari G, Langstaff RJ, Jones JW, Al-Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury. 2002;33(5):395-9.

Klinger HM, Baums MH, Eckert M, Neugebauer R. A comparative study of unstable per- and intertrochanteric femoral fractures treated with dynamic hip screw (DHS) and trochanteric buttress plate vs. proximal femoral nail (PFN). Zentralbl Chir. 2005;130(4):301-6.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51(4):737-55.

Wang HH, Shu WB, Lan GH. Network meta-analysis of surgical treatment for unstable femoral intertrochanteric fractures. Oncotarget. 2018;9(35): 24168-77.

Mangram A, Moeser P, Corneille MG. Geriatric trauma hip fractures: is there a difference in outcomes based on fracture patterns?. World J Emerg Surg. 2014;9(1):59

Fogagnolo F, Kfuri M, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124(1):31-7.

Buecking, B, Bliemel C, Struewer J. Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life. BMC Res Notes. 2012; 5:651.

Smeets SJM, Kuijt G, van Eerten PV. Z-effect after intramedullary nailing systems for trochanteric femur fractures. Chin J Traumatol. 2017;20(6):333-8.

Jonnes C, Sm S, Najimudeen S. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw (DHS). Arch Bone Joint Surg. 2016;4(1):23-8.

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.

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 Interv Aging. 2014;9:569-74.

Weiser L, Ruppel AA, Nüchtern JV. Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg. 2015;135(8):1101-6.

Gadegone WM, Salphale YS. Proximal femoral nail - an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2007; 31(3):403-8.

Jozy TN, Jacob C. Functional outcome following treatment of inter trochanteric fractures in elderly patients. Int Med Jour. 2015;2(2):87-91.

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Published

2024-04-29

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Original Research Articles