A prospective study of management of inter-trochanteric fractures of femur by modified intramedullary implant

Abstract

Background: The best surgical strategy for extra-capsular proximal femoral fractures (PFFs) is controversial in the elderly. Poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices, which predominantly consist in dynamic hip screw-plates and proximal reconstruction nails. Hypothesis: The lag screw of the modified intramedullary implant achieves better cancellous bone compaction in the femoral neck, thereby decreasing the risk of secondary displacement. Materials and Methods: We studied consecutive cases of modified intramedullary implant fixation performed between 2019 and 2021 in 20 patients (8 females and 12 males) with a mean age of 71.3 ± 9.02 years. All patients were operated on under hypotensive spinal-epidural anaesthesia in a supine position on a traction table. Patients were evaluated at pre-op and post-op follow-up periods with serial radiography and clinically by Harris Hip score (HHP) for pain and disability scoring. Results: Mean follow-up in the 20 patients was 12.3 ± 7.5 months (4–20 months). Fracture union was consistently achieved, after a mean of 12.25 ± 1.67 weeks. After the last follow-up, the mean Harris hip score was 86.8 ± 7.3 (range, 65–100); the score was excellent in 11 patients (55%), good in 5 (25%), fair in 2 (10%), and poor in 1 (5%). Conclusion: Modified intramedullary implant has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures. However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.