Functional outcome of subtrochanteric fracture fixed with long proximal femoral nail

Abstract

Background: Subtrochanteric fractures are fractures that occur in a zone extending from the lesser trochanter to 5cm distal to the lesser trochanter, however extension into the intertrochanteric region is common. These fractures account for 10-30% of all hip fractures. Closed proximal femoral nailing provides a rigid fixation with better control of rotation and axial translation, while preserving the hematoma and periosteal envelope to aid healing. We study the functional outcome in patients of subtrochanteric fractures of the femur fixed with long proximal femoral nail.Materials and methods: These is a prospective study which was carried out from June 2015 to June 2017 in Vinayaka Missions Kirupananda Variyar Medical College and Hospital, Salem, Tamilnadu. In this study period 30 cases of Subtrochanteric femur fracture of hip were studied and operated with PFN. Results: Cases were distributed across all other types with one case belonging to Type 4 fracture. Majority of the cases (18) were due to high energy trauma of Road traffic Accidents involving relatively younger patients. All except one patient underwent the surgery within 2 weeks of admission. The operating time for 60% cases was between 2-2.30 hours. The average length of Hospital stay was 14.8 days. At the end of five months, all except five patients could mobilise independently without any aid. 2 patients were using crutch and 3 patients were mobilizing using walker at 5 months of follow-up. We did not come across complications like fracture of femur and failure of fixation. None of the cases needed a reoperation. We feel that the Proximal Femoral nail is a better implant in treating subtrochanteric fracture of femur. Conclusion: From this study PFN is a good implant for subtrochanteric fracture of the femur. Fractures united in all cases and postoperative functional outcome was satisfactory. Early mobilization is an advantage with PFN. PFN could be a preferred implant of choice in treating subtrochanteric fractures especially in elderly since it allows early and stable mobilization.