A Retrospective Study on the Functional and Radiological Outcomes of Basicervical Femoral Neck Fractures Treated with Proximal Femoral Nail

Abstract

Introduction: Basicervical fractures are one of the rarest peritrochanteric fractures. They have an inherent instability which make makes them notoriously prone for treatment failure. Because they cannot be classified as neither strictly intertrochanteric, nor intracapsular fractures, their treatment protocol is also not standardized. Newer implants are regularly tested in their management, with varying degrees of success. Aim: To assess the functional and radiological outcome of basicervical neck of femur fracture with the use of the proximal femoral nail. Materials and Methods: This retrospective study was conducted in Department of Orthopaedics at Malabar Medical College Hospital and Research Centre, Kozhikode, Kerala, India, from September 2021 to December 2021. It was performed on 31 patients who were identified from a patient pool of 1526 individual with neck of femur fracture, as having basicervical fracture, but one patient follow-up details were not available hence total sample size was 30. The patients were followed-up for a year and the functional outcome was assessed using modified Harris Hip Score and classified as poor, fair, good, or excellent. Radiological outcome was assessed based on reduction. Reduction was classified as anatomical (deviation <5°), acceptable (deviation 5-10°) or bad (deviation >10°) as per the classification suggested by Hardy et al.,. Descriptive statistical measures, namely mean, frequency and standard deviation were calculated. Results: With the Proximal Femoral Nail (PFN), anatomical reduction was attained in 22 subjects (73.3%), acceptable in six subjects (20%) and bad in two subjects (6.7%). There were no instances of deep vein thrombosis, non union or avascular necrosis head of femur. The average time to radiological union was 13.5±1.8 weeks. Using modified Harris Hip Score, functional outcome was poor in two patients (6.7%) , good in two patients (6.7%) and excellent in 26 patients (86.6%). Conclusion: The PFN, even though phased out in first world countries, is a safe and viable implant choice for the management of Basicervical femoral neck fractures, with good functional and radiological outcome.