Management of sub-trochanteric femoral fractures in adults using proximal femoral nail in lateral position: a prospective study
Keywords:Subtrochanteric region, Proximal femoral nail, Valgus, Non-union, Load-bearing
Background: Subtrochanteric fractures are devastating injuries that not only affect the elderly but also the young. Despite marked improvement in implant design, surgical technique and patient care; subtrochanteric fractures continue to consume a substantial proportion of our health care resources.
Methods: This prospective study consists of 20 adult patients of subtrochanteric fractures of femur, who were treated with internal fixation using PFN. All patients were followed up at an interval of 4 to 6 weeks till fracture union and then once in 3 months till 1 year.
Results: Anatomical results are noted as good or poor depending upon shortening, varus deformity, hip movements and knee movements and functional result as excellent, good, fair and poor depending upon the hip pain, ambulatory status, ability to squat, and sit cross leg. In the study 2 patients had shortening of l cm. None of the patients had any varus deformity. Overall excellent to good results were achieved in 85% cases.
Conclusions: The potential advantages of the proximal femoral nail over extramedullary devices with regards to minimal invasiveness due to closed technique and minimal soft tissue dissection, better biomechanical design to prevent implant failure and ability to bear more stress, shows that this technique holds considerable promise in complex fractures. Early rehabilitation, less blood loss, less surgical trauma, cosmetic incision, make it the implant of choice in complex, comminuted unstable subtrochanteric fractures in adults.
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