A clinical study to evaluate the effectiveness of the short proximal femoral nail in the management of unstable intertrochanteric fractures

Ahmed Rayan Jelani; Mohammed Ismail Hathiwale; Vishwas Vittal Mundewadi; Owais Ahmed

doi:10.18203/issn.2455-4510.IntJResOrthop20190796

Authors

Ahmed Rayan Jelani Department of orthopedics, Al Ameen Medical college vijayapura, Karnataka, India
Mohammed Ismail Hathiwale Department of orthopedics, Al Ameen Medical college vijayapura, Karnataka, India
Vishwas Vittal Mundewadi Department of orthopedics, Al Ameen Medical college vijayapura, Karnataka, India
Owais Ahmed Department of orthopedics, Al Ameen Medical college vijayapura, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20190796

Keywords:

Bone nails, Fracture fixation, Intramedullary, Hip fractures, Unstable inter-trochanteric, Short proximal femoral nail, Kyle’s criteria

Abstract

Background: The objective was to study the effectiveness and drawbacks of short proximal femoral nail in the management of unstable intertrochanteric fractures.

Methods: This prospective study was conducted in the department of orthopaedics Al-Ameen medical college, Vijayapura, Karnataka, India from July 2010 to June 2017. Total 175 patients (130 males and 45 females) aged between 41 to 80 years with unstable Intertrochantreric fracture (155 had type IV and 20 had type III according to Boyd and Griffin classification). All patients were operated using Short proximal femoral nail and followed at least for a minimum period of 6 months and were evaluated radiologically and clinically by Kyle’s Criteria.

Results: Anatomical reduction was achieved in 125 patients, 105 (60%) had no complications post operatively. Complications included 5 cases of avascular necrosis and screw cut out, 5 cases of delayed union, 5 cases of Z-effect, 20 cases of varus malunion, 10 cases of antirotation screw breakage, 5 cases of distal bolt breakage and 15 cases with lateral thigh discomfort. 125 patients had No shortening and the average shortening was 0.34 cm, average time of union was 19.26 weeks (15-30 weeks) in 170 cases. At the end of 6 months, good to excellent results were seen in 71.5% of cases, 57% patients returned to their pre injury functional level.

Conclusions: Short proximal femoral nail provides good fixation for unstable intertrochanteric fractures, if proper pre-operative planning, good reduction and surgical techniques are followed leading to high rate of bone union and minimal soft tissues damage especially for Asian patients with relatively small femora.

Metrics

Metrics Loading ...

References

Kulkarni GS, Limaye R, Kulkarni M, Kulkarni S. Intertrochanteric fractures. Indian j orthop. 2008;40:16-23.

Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Pa¬tients with femoral neck and intertrochanteric fractures: Are they the same? Clin Orthop.1996;330:166-72.

Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury. 1989;20:227-31.

David A, van der Heyde D, Pommer A.Therapeutic possibilities in trochanteric fractures: safe-fast-stable. Orthopade. 2000;29:294-301.

Schipper IB, Steyerberg EW, Castelein RM,van der Heijden FH, den Hoed PT, Kerver AJ, et al. Treatment of unstable trochantericfractures: randomised comparision of the Gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004;86:86-94.

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

Gadegone WM, Salphale YS. Short Proximal Femoral Nail Fixation for trochanteric Fractures. J Orthop Surg. 201;18(1):39-44.

Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979;61:216–21.

Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58:853-66.

Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75:797-8.

Pavelka T, Houcek P, Linhart M, Matejka J. Osteosynthesis of hip and femoral shaft fractures using the PFN-long. Acta Chir Orthop Traumatol Cech. 2007;74(2):91-8.

Wu CC, Shih CH, Lee MY, Tai CL. Biomechanical analysis of location of lag screw in treatment of unstable intertrochanteric fractures. J Trauma. 1996;41:699-702.

Canale ST, Beaty JH, editors. Campbell's Operative Orthopedics. 11th ed. Philadelphia: Mosby Elsevier; 2008.

Haidukewych GJ. Inter-trochanteric fractures: ten tips to improve results. J Bone Joint Surg Am. 2009;91:712-9.

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

Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop. 1980;146:53-6.

Bucholz RW, Heckman JD, Koval KJ, Zukerman JD. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2005.

Anglen JU, Weinstein JN. Nail or plate fixation of inter-trochanteric fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery database. J Bone Joint Surg Am. 2008;90:700-7.