Role of long proximal femoral nail fixation in reverse oblique & subtrochanteric fractures of femur

Abstract

Background: Reverse oblique & Subtrochanteric fracture both are variants of Peritrochanteric femur fractures. Incidence of these fractures is increasing due to high velocity automobile accidents. They are one of the most difficult fractures to treat and even treatment failure is common. Aim: To study the functional outcome of Reverse oblique & Subtrochanteric fractures treated with Long Proximal femoral nail. Material & Methods: Total 20 (18 Male & 2 Female) cases of Reverse oblique (8 cases) & Subtrochanteric (12 cases) fractures from 2011 to 2016 were treated by Long proximal femoral nail. Mean patient age was 50 yrs (25 – 75 yrs). All patients operarted on fracture table in supine position. Average hospital stay was 3 weeks. Results: Road traffic accident was commonest mechanism of injury. 10mm was frequently used diameter. 4 cases required Open reduction. Non weight bearing mobilization was initiated by post op day 3(Average 2-5). Average fracture union time was 16 weeks. Average duration of follow up was 1 year. Shortening of 1cm was seen in 1 case, Reverse Z effect was seen in 2 cases, nail breakage was seen in 1 case which didn’t affect the functional abilities. Good to excellent results as per Harris Hip Score seen in 90% cases. No Z effect & Non-union was seen in any case. Conclusion: With the various choices of implants for the fixation of Reverse oblique & subtrochanteric fractures Long PFN can be considered a reliable implant due to following advantages of being minimally invasive, load shearing device, facilitates early mobilization. However anatomical reduction & optimal placement of implant is the key to success. Limitations of study: Small sample size, Short follow up period, no comparison group