Management of Sub-trochanteric Fractures by Long Proximal Femoral Nail in Young Adults
Background: Sub-trochanteric fractures are difficult to manage and are frequently associated with complications, owing to high stresses in this region. We evaluated the outcome of long proximal femoral nailing in management of these sub-trochanteric fractures.
Material and methods: 32 patients of closed sub-trochanteric fractures of femur in patients more than 18 years’ age were treated with long proximal femoral nail and were assessed functionally by Harris Hip Score and radiologically to assess union.
Results: 32 patients of sub-trochanteric fractures with mean age 50.09 years treated with long proximal femoral nailing were included in the study. 24 were male and 8 were female. Right side was affected in 18 cases and left in 14 cases. Mean operative blood loss was 122.6 ± 27.6 ml (range 110 to 143 ml). The mean union time was 14.37 weeks (range 12 to 24 weeks). The mean Harris Hip score was 85.9. Only one patient had complication in form of proximal screw back out.
Conclusion: Long proximal femoral nailing provides reliable and excellent to good results in the management of difficult sub-trochanteric fractures, with minimal complications, but the surgery is technically demanding and requires learning curve.
Nath RG, Ansari S. Role of Proximal Femoral Locking Plate in treatment of Subtrochanteric Fractures. Med Pulse Int J Orthop. July 2017;3(1):1-7.
Ibrahim S, Meleppuram JJ. A retrospective analysis of surgically-treated complex proximal femur fractures with proximal femoral locking compression plate. Rev Bras Orthop. 2017 Jan 7;52(6):644-50.
Jansen H, Doht S, Frey SP, Meffert RH. Subtrochanteric femoral fractures: influence of patient age on fracture type and mobility. J Orthop Sci. 2013 May;18(3):451-5.
Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculo skelet Disord. 2018 Oct 12;19(1):369.
Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD000093.
Chinoy MA, Parker MJ. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies. Injury. 1999 Apr;30(3):157-63.
Herrera A, Domingo LJ, Calvo A, Martínez A, Cuenca J. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop. 2002;26(6):365-9.
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 Feb;74(1):53-8.
Edwards SA, Pandit HG, Clarke HJ. The long gamma nail: a DGH experience. Injury. 2000 Nov;31(9):701-9.
Kamboj P, Siwach R, Kundu Z, Sangwan S, Walecha P, Singh R. Results of Modified Proximal Femoral Nail in Peritrochanteric Fractures in adults. Internet J Orthop Surg. 2006;6(2): 1-6.
Harrington KD, Johnston JO. The management of comminuted unstable intertrochanteric fractures. J Bone Joint Surg Am. 1973 Oct;55(7):1367-76.
Lechner JD, Rao JP, Stashak G, Adibe SO. Subtrochanteric fractures. A retrospective analysis. Clil Orthop Rel Res. 1990 Oct(259):140-5.
Pelet S, Arlettaz Y, Chevalley F. Ostéosynthèse des fractures per- et sous-trochantériennes par plaque angulée versus clou Gamma. Uneétude prospective randomisée [Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study]. Swiss Surg. 2001;7(3):126-33.
Manu KT, Kumar A, Ravi KB. Treatment of subtrochanteric femur fractures with proximal femoral nails: a prospective study. J applied Res. 2019;9(4):25-7.
Harshwardhan H, Jain S, Sharma M. An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II. Int J Res Orthop. 2019;5:699-702.
Liu Y, Tao R, Liu F, Wang Y, Zhou Z, Cao Y, Wang H. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. 2010 Aug;41(8):810-7.
Kashid MR, Gogia T, Prabhakara A, Jafri MA, Shaktawat DS, Shinde G. Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures. Int J Res Orthop. 2016;2:354-8.
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