USE OF PROXIMAL FEMORAL NAIL IN PATIENTS WITH UNSTABLE EXTRACAPSULAR PROXIMAL FEMORAL FRACTURES: A CLINICAL OUTCOME STUDY

Abstract

Introduction: Unstable trochanteric and subtrochanteric fractures are biomechanically unfavorable fractures and often associated with complications such as cut-out, excessive sliding or varus.The reoperation rate is approximately 10%. The forces that tend to displace the fracture must be neutralized by the implant. The proximal femoral nail is an intramedullary implant and associated with less blood loss and lower infection rate,and allows direct full weight bearing because of its favorable biomechanical properties. In the present study we have observed the functional outcome in unstable extra capsular proximal femoral fractures managed by proximal femoral nail using by ICF (International Classification of Functioning, Disability and Health) questionnaire. Material & Method: It was a clinical outcome observation study carried out in eighty patients of unstable extracapsular proximal femoral fractures presented in the department of Orthopaedics DR. RPGMCH, Tanda over a period of one year from 1st April 2013 to 31st March 2014. Patients were assessed functionally by ICF (International Classification of Functioning, Disability and Health) questionnaire on one and half month, three month and sixth month of surgery. Results: There was female preponderance with female/male ratio being 46/34. Postoperative health assessment was done by using ICF method where we did the assessment of general, mental and emotional health. After 6 months of the surgery, a total of 66.6% patients rated their health as good to very good and 79 patients had mild to moderate impairment because of pain. In terms of functional assessment,sixty eight percent (68.52%) patients had no to mild impairment in the performance and the capacity and 31.48% patients had moderate impairment in performance and capacity for washing oneself.None of the patients observed with severe to very severe limitation after the surgery.Seventy percent (70.0%) patients had mild to moderate impairment in the performance and the capacity and 29.37% patients had severe impairment in performance and capacity for toileting and dressing. Conclusion: It is concluded that a significant change was seen in quality of life of patients postoperatively as evidenced by ICF questionnaire used in present study.