TO EVALUATE RADIOLOGICAL AND FUNCTIONAL OUTCOMES OF INTRAMEDULLARY OSTEOSYNTHESIS OF SUBTROCHANTERIC FEMUR FRACTURES IN ADULTS WITH LONG PROXIMAL FEMORAL NAIL

Abstract

Background: The subtrochanteric fractures accounts for 10-34% of hip fractures. Operative treatment is gold standard in adults in view of anatomical location, deforming forces & vascularity issues. Intramedullary device are less invasive, more biological & mechanically stable whereras extramedullary methods achieves better anatomical reduction but at the expense of vascularity. However, there is still no consensus over the methodology for being the best for these fractures. Objective: To evaluate clinical, functional and radiological outcomes of intramedullary osteosynthesis of subtrochanteric femur fractures in adults with long PFN. Methods: A prospective randomized control study was conducted on total 30 patients of subtrochanteric fractures and treated with long proximal femoral nail (PFN). All the patients were followed up for a maximum of 24 weeks. Outcomes were observed & analysed such as tip apex distance, duration of surgery, complications, functional and radiological outcomes. Results: The average age of patients was 43.6 years ±13.26. Left sided fracture were more than right sided fracture. The most common type of fracture as per AO-ASIF classication was 32-C3 (53.33%). In 21 patients compression screw used was 95mm or above. Derotation screw of size 85mm or above were inserted in 19 patients. Mean TAD of compression screw and derotation screw was 11.59 and 13.81 respectively. Closed reductions was achieved in 27 patients. Mean surgical time was 157 minutes. Mean radiological union time of fracture was 14.16 weeks. Mean Harris hip score at 24 weeks was 84.56. Conclusions: It is concluded that intramedullary xation by long PFN is a sound and effective modality for the subtrochanteric fractures. Subchondral xation of both proximal screws probably has led to better stable xation with hundred percent union rates and no implant failure.