Management of sub-trochanteric femoral fractures in adults using proximal femoral nail in lateral position: a prospective study

Authors

  • Ansari Muqtadeer Abdul Aziz Associate Professor, Department of Orthopaedics, Government Medical College, Aurangabad, Maharashtra, India,
  • Rahul Gopikishan Jaju Assistant Professor, Department of Orthopaedics, Government Medical College, Aurangabad, Maharashtra, India,
  • Ajit J. Deshmukh Department of Orthopaedics, Hospital for Special Surgery, New York, USA

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20181796

Keywords:

Subtrochanteric region, Proximal femoral nail, Valgus, Non-union, Load-bearing

Abstract

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.

References

Lavelle DG. Campbells Operative Orthopaedics, tenth edition, Fractures and dislocations. Volume 3. Chapter 52. 2012: 2897-2908.

Kyle Richard F, Campbell Sara J. In: Campbell Operative Orthopaedics, Intertrochanteric fractures. Chapter 40. Volume 1. 2016: 600-603.

Pavelka T, Kortus J, Linhart M. Osterosynthesis of proximal femoral fractures using short Proximal Femoral Nail. Acta Chir Orthop Traumatol Cech. 2003;70(1):31-8.

Bedi A, Le TT. Subtrochanteric femoral fractures, OCNA. 2004;35:473-83.

Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical review of Gamma Nail. JBJS Br. 1992;74:352-7.

Mckibbin B, The biology of fracture healing in long bones, JBJS (Br). 1978;60:150-62.

Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Surg Br. 1992;74(3):345-51.

Albareda J, Laderiga A, Palanca D, Paniagua L, Seral F. Complications and technical problems with Gamma Nail. Tnt Orthop. 1996;20:47-50.

Valverde JA, Alonso MG, Porro JG, Rueda D, Larrauri PM. Use of the Gamma Nail in the treatment of proximal femur. Clin Orthop. 1998;350:56-61.

Randle JA, Meisami-Fard B, McKee MD. Mechanical failure in a patient with impending pathologic subtrochanteric fracture. Canadian J Surg. 1999;42:384-6.

Bouldin C, Seibert FJ, Fankhauser F. The PFN as a minimal invasive treatment of unstable proximal femoral fractures, a prospective study of 55 patients with follow up of 15 months. Acta Orthop Scand. 2003;74(1):53-8.

Simmermacher RKJ, Bosch AM. The AO-ASIF Proximal femoral nail(PFN), a new choice for the treatment of unstable proximal femoral fractures. Injury. 1999;30:327-32.

Parker MJ, Handoll HH. Gamma and other Cephalocondylic intramedullary nails vs extra-medullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2002: 1-55.

Downloads

Published

2018-04-25

Issue

Section

Original Research Articles