To Evaluate The Outcome of Proximal Femoral Nail A2 in Management of Inter-trochanteric Fractures of Femur in Elderly

Abstract

Introduction- The incidence of inter-trochanteric fracture in the elderly is rising because of increased age and with low bone mineral density. The presence of osteoporosis in inter-trochanteric fractures is important because the fixation of the proximal fragment depends entirely on the quality of the cancellous bone present. The surgical stabilization of inter-trochanteric fractures remains a persistent challenge. The purpose of this study is to study the effectiveness and drawbacks of one such newer intramedullary device, Proximal Femoral Nail Antirotation in the management of inter-trochanteric fractures. Material and method- Patients who underwent PFNA for inter-trochanteric fractures at a tertiary care center Agra, who have given written and informed consent. Patients fitting into inclusion criteria would form the study group. Data collected by interviews, observation of clinical and radiological findings and assessment of function done using Harris hip score. Results- The study comprised 24 patients, with a mean age of mean age 63 years who suffered fracture inter-trochanteric femur, due to either trivial fall (75%) or RTA (17%) and managed by cephalomedullary nailing using Proximal Femoral Nai Antirotation at our center. The majority of the patients had the quality of reduction; the Majority of patients took 12 to 22 weeks for union with mean union time of 14 weeks. Patients were asked to follow up routinely, with post-operative follow up ranging from a minimum of 11 months to 18 months. At the final follow up following results obtained according to Harris Hip Score, were 55% patients excellent, 30.50% patients good, 12% patients fair, 2.50% patients poor. Conclusions- The inter-trochanteric fracture in elderly patients treated with cephalomedullary nailing using proximal femoral nail-anti-rotation, which has the biomechanical advantage of the helical blade providing bone compaction, increasing surface area and better anchorage in the femoral head, which showed favorable outcome by retarding rotation and varus collapse and prevents medialization by acting as a central pillar. Keywords- Inter-trochanteric fractures; Proximal femoral nail A2; Harris Hip Score.