Outcomes of proximal femoral nail in subtrochanteric femur fractures through medial entry

Abstract

Introduction: Subtrochanteric Fractures of Femur accounts for 10-34% of all hip fractures. Several Methods of treatment of this Fractures have been reported like DHS (Dynamic hip screw), Angled blade Plate, Proximal Femur Locking Plate and Intramedullary devices. Currently Intramedullary Devices like Proximal Femur Nail are used by many giving satisfactory results in subtrochanteric femur fractures. In such situation as Suggested by Richardu et. el. slight medial entry leads to valgus alignment which is desired along with the anatomical reduction while nailing subtrochanteric fractures. In the study conducted by perez et al. Suggested that slight more medial entry also protected abductors and caused no damage. Materials and Methodology•All the patients of subtrochanteric femur fractures treated with long proximal femur nail through medial entry will be called for follow up and data is collected as per the performa •Functional assessment will be done using Harris Hip Score.Discussion: Utiizing the tip of the trochanter as a starting point led to both varus and valgus malalignments.Using the Trochanteric Fixation Nail (TFN) with a lateral to the tip of the trochanter, starting point demonstrated 6.83° varus and a gap of 8.03 mm. A medial starting point resulted in 6.6° valgus with a mean gap of 3.88 mm and a tip starting point showed 0.3° varus and 3.56 mm of gapping. In the above conducted study there was a valgus angulation at the proximal femur due to medial entry of the proximal femur nail.Conclusion: From this sample study, we conclude that Proximal Femoral Nail through medial entry is a good method for the treatment of Subtrochanteric fractures of femur provided optimal reduction of the fracture and good positioning of the nail and screws are achieved.