A prospective study of surgical management of fractures of proximal femur using proximal femoral nail

Abstract

Background and Objectives: Proximal third fractures of femur like intertrochanteric and subtrochanteric fractures, are a leading cause of hospital admissions in elderly people. The number of such admissions is on a raise because of increasing life span and sedentary habits. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. This study is done to analyze the surgical management of proximal third fractures of femur using Proximal Femoral Nail. Methods: This is a prospective study of 30 cases of fresh trochanteric and subtrochanteric fractures admitted to Vijayanagar institute of medical sciences Ballari From september 2015 to august 2017. Cases were taken according to inclusion and exclusion criteria i.e., patients with Proximal third fracture femur above the age of 18yrs. Medically unsuitable and patients not willing for surgery were excluded from the study. Results: In our series of 30 cases there were 19 males and 11 females, maximum age of 81 and minimum age of 21 years most of the patients were between 61-80 years. Mean age of 57.4 years. 80% cases were admitted due to slip and fall and with slight predominance of right side. Out of 30 cases, 19 were trochanteric and 11 were subtrochanteric. In trochanteric fractures 36.84% were Boyd and Griffin type 2, in subtrochanteric fractures 27.27% were Seinsheimer type 3a. Mean duration of hospital stay is 15 days and mean time of full weight bearing is 15 weeks. 30 case were followed up. Out 30 cases 19 trochanteric and were 11 subtrochanteric. Good to excellent results are seen in 89.47% of trochanteric fractures and 81.81% subtrochanteric fractures. Overall, we had good to excellent results in 86.66%, fair in 13.33%, we had no case with poor results. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of Peritrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier and exactly performed osteosynthesis.