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Abstract
BACKGROUND AND OBJECTIVES:
Subtrochanteric fractures of the femur remain some of the most challenging fractures facing orthopaedic surgeons. Most of the fractures in the elderly results from trivial fall from standing or walking, while in the younger age group it’s mainly due to road traffic accidents. Closed management of these subtrochanteric fractures thus poses difficulties in obtaining and maintaining a reduction, making operative management the preferred treatment
Hence this study is intended to determine the effectiveness of intramedullary fixation of subtrochanteric fractures with proximal femoral nail and the complications involved in the management of subtrochanteric fractures.
METHODOLOGY:
This is a prospective study of 30 cases of Subtrochanteric fracture admitted to Bowring and Lady Curzon and Victoria Hospitals between October 2007 and July 2009 treated with Proximal femoral nail. Cases were taken according to inclusion and exclusion criteria i.e., fresh Subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study.
RESULTS:
In our study of 30 cases, there were 25 male and 5 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years. 67% of the cases admitted were road traffic accidents, 23% due to fall from height and 10% due to trivial fall with right side being more common side affected.. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 24 days and mean time of full weight bearing was 14 weeks in our patients. Out of 30 cases, 3cases were lost in follow up and 1 case died. Good to excellent results were seen in 80% of cases in our study.
CONCLUSION:
From our study we conclude that PFN is a reliable implant for subtrochanteric fractures, leading to high rate of bone union and minimal soft tissue damage.Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.
