Functional outcomes of subtrochanteric femur fractures treated by intramedullary proximal femur nail

Abstract

Introduction: Subtrochanteric fractures are femoral fractures where the fracture occurs below the lesser trochanter to 5 cm distal in the shaft femur. These fractures account for 10-30% of all hip fractures. They have bimodal distribution patterns and different mechanism of injuries in both age groups. A significant force is required to fracture this bone in adult individuals, which mainly happens with high energy injury like motor vehicle accident or fall from significant height, whereas in old people, it occurs due to trivial trauma, because of weak bone. Because of complex anatomy, strong muscle pull and highly stressed region in the body, the reduction of subtrochanteric femur fracture is one of the biggest challenges in traumatology. Various modalities of treatment for fractures of subtrochanteric femur are available i.e. traction, casting, bracing, pin and plaster, plate osteosynthesis, Dynamic compression plate and screw. Dynamic hip screw and plate, external first generation centromedullary nail, second generation cephalomedullary nail and third generation proximal femur nail. Each method carries its advantages and disadvantages. 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. This is a prospective study of subtrochanteric fractures of the femur treated with proximal femur nailing at Aalok hospital, Ahmedabad. Aim: To study outcomes in patients of subtrochanteric fractures of the femur treated with proximal femur nailing Materials and Methods: This was prospective study of 51 cases of subtrochanteric femur fractures in 50 patients treated with proximal femur nail; with maximum period of follow up of 29 months and minimum period of follow up of 6 months with average period of follow up of 15 months. Harris hip score was used for the evaluation of results in our series Results and discussion: In our series, we observed excellent result in 39 patients, good results in 3 cases and poor results in 5 cases. The poor result in one patient (case 5) was basically because of pathological fracture which lead to delayed union and low Harris Hip score. In two fractures the associated injuries i.e. tibia fibula fracture in case 7 and large thigh wound in case 15 contributed to poor results, whereas in case 13 the result was due to implant failure. The mean Harris hip score in our series was 90.1, which is higher than in the other series (84.6 in IJO study 2001-03 = 80.4 in Scripta Medica study). In addition we have also evaluated the patient's satisfaction which has patients were satisfied in our study. Conclusion: From our study, we concluded that, Proximal femoral nail is a good implant for pathological subtrochanteric femoral fractures. Proximal femoral nail spanning whole femur with proximal and distal locking, an intramedullary load sharing implant, appears to be satisfactory implant in management of fractures of subtrochanteric femur 2-C.