A PROSPECTIVE STUDY OF INTERTROCHANTERIC FRACTURE MANAGEMENT IN ADULTS BY PROXIMAL FEMORAL NAIL (PFN)

Abstract

Background: Intertrochanteric fracture in younger individuals are usually the result of high energy injury, such as motor vehicle accidents or fall from height. In elderly 90 % of intertrochanteric fracture results from simple falls. All treatment modalities are aimed at preventing malunion and deformity. Both the methods of non operative and operative managements have strong advocates. Now a days, conservative method of treatment of intertrochanteric fracture have been largely abandoned. Rigid internal fixation of the intertrochanteric fractures with early mobilization is considered as standard treatment. Aims And Objectives: To analyze the results of proximal femoral nailing in the management of intertrochanteric fractures. Methodology: A prospective interventional study was done at Vinayaka Missions Kirupananda Variyar Medical College, Salem between August 2013 to August 2015. 30 patients who were clinically and radiologically diagnosed as intertrochanteric fractures were included in the study. The fractures were classified based on Boyd and Griffin classification. The patient had undergone proximal femoral nailing under c-arm. All the patients were assessed by using Kyle’s criteria during the follow up period. The patients were followed up for a period of 3 to 6 months. Results: Majority of the patients had developed the intertrochanteric fractures mainly due to road traffic accidents (76.6%). Based on Boyd and Griffin classification majority of patients had type II fractures. Among the 30 patients 25 patient had undergone closed reduction and remaining 5 patients had open reduction. The mean time for the fracture union was 5.13 month for the patient who had undergone closed reduction type of surgery and it was 5.81 month among the patients undergone open reduction. Based on Kyle’s criteria the functional outcome at end of 6 months was excellent for 10 patients and the outcome was good for 16 patients and outcome was fair for 3 patients and only one patient had a poor outcome at the end of 6 months due to delayed union of the fracture. Conclusion: Proximal femoral nail is a better implant for unstable type of intertrochanteric fractures as our study show excellent and good functional results with no implant related complications Keywords: Intertrochanteric fracture, proximal femoral nailing, hip fractures