Results of proximal femoral nail in unstable intertrochanteric fracture of femur

Abstract

Introduction: Intertrochanteric Femur fractures comprise approximately half of all hip fracture caused by low energy mechanism. These hip fractures occur in characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of fall and gait abnormality. In spite of great advances made in the field of trauma in last 50 years, management of this fracture has always remained subject of debate. There are several internal fixation options for managing these fractures that generally fall into two categories: some form of intramedullary fixation or some form of plating. Proximal Femoral Nailing is load bearing device with rotational stability and also short lever arm in addition to indirect fracture reduction. In this article we will discuss the role of proximal femoral nail in unstable intertrochanteric femur fracture.Materials & Methods: We have done a prospective study in 40 patients of unstable intertrochanteric femur fractures of femur operated with proximal femoral nailing at our institute with follow up of 5 – 24 months. All patients above 31 years of age with proximal femur fractures of femur admitted in tertiary center meeting the inclusion and the exclusion criteria during the study period were the subjects for the study. Patient were regularly followed up radiologically. Final outcome is measured with Harris Hip Score.Results: In the present study, 40 cases of unstable intertrochanteric fractures treated operatively with proximal femoral nail (PFN), and the results were analyzed. In this series, low velocity injury (Domestic fall) was the cause of fracture in the majority (70%), especially in the elderly female patients. The operations were completed within 2 hours in 98% of the patients. For PFN minimum duration was 40 minutes and maximum duration was 150 minutes and mean duration was 80 minutes. One patient had outward migration of screw, one patient had backout of derotation screw, 7 patient had varus collapse, five patient had abductor weakness on followup. On 6 month follow up thirty patient had separated lesser trochanter with union of fracture but there was no limitation of movement & any residual deformity. The functional result according to Harris Hip Score was found to be excellent in 54%, good in 26%, fair in 10% and poor in 10% of patients.Conclusion: Intertrochanteric fractures commonly occur in elderly persons, usually following minor trauma whereas in young patients a major trauma is needed to cause this fracture. Proximal femoral nail offer less invasive option for fixation of unstable intertrochanteric hip fractures. Unstable fractures can be fixed faster and with lesser soft tissue dissection. On basis of our study we have concluded that PFN should be considered for management of unstable intertrochanteric fractures in young as well as elderly patients who have multiple pre-existing illness.