Abstract
Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11718 Bangladesh Journal of Medical Science Vol. 11 No. 03 July12
Highlights
Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries
Flexible nails are not suitable for proximal fractures and can withstand only 40% of the body weight and recommend starting of weight bearing to be delayed until the appearance of early callus formation at three to four weeks time following the fixation
Complications as a result of the procedure were recorded in 4(11.77%) patients and included one patient (2.97%) were labeled as delayed union because of obvious gap at the fracture site in subsequent radiographs (Table V). This was due to over distraction of fracture during operation, and was treated by bone graft, two entry site skin irritations; one protrusion of the wires through the skin they had been buried during the procedure
Summary
Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. The treatment of subtrochanteric femoral fractures in children is controversial. Treatment choices are influenced by the child’s age and size and whether the femoral fracture is an isolated injury or part of a polytrauma
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