Operative results of proximal femoral nailing in subtrochanteric fracture femur using pyriformis fossa entry

Abstract

Introduction: Subtrochanteric fracture of the femur is a variant of the peritrochanteric fracture of the femur. It extends upto 5 cm below the lesser trochanter. The incidence is relatively much lower (3.9% of all the proximal femoral fractures). It is common in the older population with low energy trauma along with osteoporosis and in younger patients with high energy trauma [4]. Studies have shown that the subtrochanteric region is the most stressed area which concentrates stress on the implant and this is difficult to treat due to complications. With the improved knowledge and understanding of the fracture pattern, specific treatment options with successful results `1may be obtained. Materials and methods: A total of 36 cases of subtrochanteric femur fracture patients were selected in our study and we did proximal femur nailing in all patients, where entry of nail was taken through pyriformis fossa. Among them, 22 fractures were successfully reduced with traction on a fracture table, but circlage wiring through a small incision was needed in 6 cases. The classification of fracture was based on Russell and Taylor classification. Blood loss, duration of surgery, functional outcomes were recorded. All patients’ assessment of movement at hip was assessed by Harris hip score. Clinical and radiographic analyses were done at 3 weeks, 6 weeks, 3 months, 6 months and 1 year. Results: Out of 36, 25 were males and 11were females. One patient had rotational malallignment of 12 degrees. There were no other malallignment or iatrogenic fracture comminution. The average operative time was 48 minutes. All fractures united eventually with no bone grafting needed in any patient. The functional hip outcome in terms of scoring by Harris hip score showed excellent results on follow ups. Conclusions: A femoral nail with ante grade entry through the pyriformis fossa showed excellent results in terms of union and functional outcome of patients.