Outcome of subtrochanteric fracture of the femur managed with proximal femoral nail

Abstract

Background: Subtrochanteric fractures of the femur remain some of the most challenging fractures facing Orthopaedic surgeons. Internal fixation of these fractures has gained widespread acceptance but the problems i.e. malunion, nonunion, implant failure, refracture and infection encountered after surgical treatment of these fractures have prompted continued development of new devices and treatment programs. We study the outcome of these fractures treated with long proximal femoral nail. Methods: All patients above 16 years of age who presented to our emergency department with subtrochanteric fracture of the femur were included in the study. Radiographs were taken and all the fractures were classified according to the Seinsheimers classification. All patients underwent fixation with the proximal femoral nail. The functional outcomes of the patients were assessed using the Harris hip score. Results: There were 20 males and 6 females in our study. According to the Seinsheimers classification we had 10 patients with type II fracture, 11 patients with type III fracture, 3 patients with type IV fracture and 2 with type V fracture. The average Harris hip score at the end of 1 year follow up was 82. There were 10 patients with an excellent Harris hip score, 9 patients with a good score, 4 with fair score and 3 had poor scores. We had 8 minor complications in our study, all fractures went on to unite and there was no implant failure. Conclusions: In our study we had good results with the proximal femoral nail, it requires minimal exposure and achieves biological fixation. It allows early weight bearing which is beneficial and has fewer implant related complications. Proximal femoral nail is a good choice of implant for fixation of subtrochanteric fractures.