Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis
Keywords:Proximal femur, Intertrochanteric fractures, Subtrochantric fractures, Proximal femoral nail
Background: Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.
Methods: In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.
Results: Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.
Conclusions: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.
Babhulkar Sudhir S. Management of trochanteric Fractures. Indian J Orthop. 2006;40:210-8.
Canale ST, Beaty JH. Campbell‘s Operative orthopaedics. 12th edition. Elsevier; 2012.
Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178-208.
Cole PA, Bhandari M. What’s new in orthopaedic trauma. J Bone Joint Surg. 2005;87:2823-38.
Gadegone Wasudeo M, Salphale Yogesh S. Short proximal femoral nail fixation for trochanteric fractures. J Orthop Surg. 2010;18:39-44.
Carter D, Hayes W. The Compressive Behaviour of Bone as a Two-Phase Porous Structure. J Bone Joint Surg. 1977;7:954-62.
Lee YS, Huang HL, Lo TY, Huang CR. Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods. International Orthopaedics. 2007;31(5):683-688.
Kulkarni GS. Treatment of Trochanteric Fractures of the Hip by Modified Richard’s Compressing and Collapsing Screw. Indian J Orthop. 1984;18(1):30-4.
Dean GL, David S, Jason HN. Osteoporotic pertrochanteric fractures; management and concurrent controversies. J Bone Joint Surg Am. 2004;72:737-52.
Pajarinen J, Lindahl J, Savolainen V, Michelsson O, Hirvensalo E. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures. Int Orthop. 2004;28:347–53.
Herrera A, Domingo LJ, Calvo A, Martínez A, Cuenca J. A competitive study of trochanteric fracture treatment with the gamma nail or the proximal femoral nail. Int Orthop. 2002;26:365.
Schipper IB, Steyerberg EW, Castelein RM, van der Heijden FH, den Hoed PT, Kerver AJ, et al. Treatment of unstable trochanteric fractures. Randomised comparison of gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004;86(1):86-94.
Schipper IB, Bresina S, Wahl D, Linke B, Van Vugt AB. Schneider Biomechanical evaluation of the proximal femoral nail. Clin Orthop Relat Res. 2002;405:277–86.
Domingo LJ, Cecilia D, Herrera A, Resines C, Trochanteric fractures treated with a proximal femoral nail. Int Orthop. 2001;25:298–301.
Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)--our first 60 cases. Injury. 2002;33(5):401-5.
Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. Intra-and perioperative complications in the stabilization of per-and subtrochanteric femoral fractures by means of PFN. Unfallchirurg. 2002;105(10):881-5.
Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. J Bone Jt Surg (Br). 1992;74:352–7.