Ease of doing proximal femoral nailing in lateral position in the management of peri-trochanteric femoral fractures in adults: A prospective study

Abstract

Introduction: Intertrochanteric fractures are among the most common pei-trochanteric fractures encountered in orthopaedic practice. Most of the hip fractures are managed in supine position on a fracture table with foot attached to foot plates and biplanar fluoroscopy supervision under c-arm. But this procedure has its own difficulties in managing especially comminuted peri-trochanteric fractures, where in different fragments and segments are being pulled by strong muscles around hip, and getting good reduction and satisfactory alignment is difficult due to displaced bony fragments being held in traction on fracture table and cannot be manipulated easily. This leads to prolonged operative time, opening of fracture site, increased bleeding, and increased chances of infection and over all increased anaesthesia time adding up to risk factors. The purpose of this study was to demonstrate the technique of surgery as well as to report how these difficulties can be overcome by using long Proximal Femoral Nail in complex comminuted unstable trochanteric fractures in lateral position on an ordinary radiolucent top table without fracture table. Materials and Methods: 30 cases of peri-trochanteric fractures with or without comminution were operated in lateral position on simple ordinary radioluscent top table with lesser attachments and adjustments to operating table during the study duration were included in the study. We used long Proximal Femur Nail (PFN) (length more than 25cms 34, 36, 38, 40cms long) to fix these fractures. Results: In the present study, age group of patients was 60yrs to 78yrs. Male patients (60%) were more than female patients (40%) An average of less than 150 ml in closed surgery and 350 ml in Open reduction cases. The average operative time for all cases was 80 minutes. Union time varied from 14 weeks in simple fractures to 26 weeks in comminuted fractures. Clinical function of hip and knee was excellent with full range of movements. Overall excellent to good results were achieved in 90% cases. Conclusions: The lateral decubitus position provides easy identification of entry point, a shorter operation time, less of hospital stay, blood loss, number of intraoperative X-ray, incision length and out-of-bed activity time Reduction and fixation of proximal femoral fractures in the lateral position with fluoroscopy in the anteroposterior view for small set ups and rural hospitals that lack a fracture table or advanced fluoroscopic devices may be executable and probably safe.