Management Of Femoral Shaft Fractures Research Articles

Prospective study of surgical management of femoral shaft fractures in children using tens nail

Background: Pediatric femoral shaft fractures are uncommon, constituting less than 2% of all fractures in children; yet they are a significant burden on healthcare systems and families as they are the most common fractures requiring hospitalization in children. In the recent studies, technique of flexible stable intra medullary pinning using titanium pins which is now popularly known as TENS has become the choice of operative management for pediatric femoral shaft fractures. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods: This prospective study was carried out at Al-Ameen Medical College and Hospital, Vijayapura. Forty patients (32 males and 8 females) aged between 5-15 years with diaphyseal femur fracture were included in our study. Patients were treated with closed reduction and internal fixation with TENS. They were followed up for 6 months both clinically and radiologically. The functional outcome was evaluated using Flynn’s scoring criteria. Results: Forty patients were followed up for 6 months and their results were evaluated. The functional outcome using Flynn’s criteria was excellent in 24 patients, satisfactory in 14 patients and poor in 2 patients. Complications observed were limb length discrepancy, knee stiffness, superficial infection and nail protrusion. Conclusions: TENS has the advantages of early union, early mobilization, and manageable complications, making it an excellent choice for treating paediatric shaft femur fractures in patients aged 5 to 15 years.

Early and Mid-Term Outcomes of Nonsurgical Management of Femoral Shaft Fractures with Associated Multiple Injuries in School-Age Children

Objectives: Femoral shaft fractures associated with multiple injuries are commonly encountered in school-age children. Clinical outcomes of non-surgical management of pediatric femoral shaft frac- tures with high-energy multiple injuries are not well characterized. In this study, we evaluated the early and mid-term clinical outcomes of non-surgical management of pediatric femoral shaft frac- tures with high energy multiple injuries in our setting.

Management of Femoral Shaft Fractures: The Significance of Traction or Operative Position.

Background and objective Intramedullary femoral nailing (IMN) is the gold standard for managing femoral shaft fractures (FSFs). Though good clinical outcomes and union rates have been reported following this procedure, it has also been commonly associated with perioperative complications. Positioning the patient in lateral decubitus, avoiding a fracture table, or using manual traction have been touted as possible techniques to reduce perioperative complications in IMN. However, given the scarce availability of comparative research, the decision to employ any of the techniques mentioned above is often guided by surgeon preference alone. In light of this, the purpose of this study was to determine whether the use of free-leg draping using either supine or direct lateral positioning with manual tractionreduces perioperative complications among trauma patients undergoing an anterograde femoral nailing surgery when compared to using a fracture table. Methods Consecutive adult patients from a level-one trauma center undergoing unilateral antegrade femoral fixation surgeries between 2016 and 2020 were retrospectively evaluated for possible inclusion in the study. Relevant perioperative and postoperative data, including length of hospital or ICU stay and perioperative complications, were included in the analysis. This study received research ethics board approval before data collection began. Results A total of 91 patients were ultimately included in the final analysis: 61 patients were included in thefree-legdraping with manual traction group (FL) and 30 patients were included in the traction table group (TT). Patients in the FL group had a similar operative and fluoroscopy time, blood loss, length of stay, and time on the ventilator. Subgroup analysis comparing positioning within the FL group revealed non-significant differences in fluoroscopy time(p=0.59)and lengthof stay (p=0.20) between the lateral and supine groups. Moreover, no differences in operative time, blood loss, and time on the ventilator were observed between lateral and supine groups. Conclusion Based on our findings, there were no significant differences in terms of operative or fluoroscopy time, perioperative complications, or length of time in the hospital or on the ventilator between the groups. Our study was limited by its small sample size and incomplete data. Further prospective randomized research is required to reach definitive conclusions on the appropriate manner to treat patients with these complex and morbid injuries.

ROLE OF DYNAMIC COMPRESSION PLATE (DCP) IN FEMORAL SHAFT FRACTURES

Although intramedullary fixation has standardized the management of femoral shaft fractures, Dynamic compression plating is a useful technique and has a definite role for specific indications where intramedullary nailing may be contra-indicated or technically not feasible. Our aim is to assess and study the Femoral shaft fractures presented to orthopaedic department at Viswabharathi Medical College & General Hospital, Kurnool from November 2016 to November 2019 and to evaluate the final outcome of patients treated with Dynamic compression plate. The procedure is safe with minimal morbidity, relatively few complications and helpful in early recovery after surgery.

COMPARISION OF LANDMARK GUIDED FEMORAL NERVE BLOCK AND SYSTEMIC INTRAVENOUS ANALGESIA FOR PAIN RELIEF IN TRAUMATIC SHAFT FEMUR FRACTURE.

Background: Femoral nerve block is useful technique for acute pain relief in case of fracture shaft femur in comparison to systemic analgesia. a) To study and compare whether femoral nerve block is more efficaciousAims and Objective: in pain management of femoral shaft fractures than systemic intravenous analgesia. b) To study the duration of action of femoral nerve block for pain relief in femoral shaft fractures. c) To notify any complication. 60Materials and Methods: patients of ASA I and II, aged 20-60 years, having fracture traumatic shaft femur at either level (mid, upper, lower) were studied after admission of patient in emergency ward. They were randomly allocated to group A (n-30, femoral nerve block using 15 ml 2% Lignocaine) and group B (n-30, systemic analgesia using Inj. Paracetamol 1 gm). Each case was subsequently followed up for onset and total duration of analgesia till 6 hrs. Efficacy in both groups was assessed by visual analogue scale. There is no significant difference in onset of action between both theResults and Summary: groups. The duration of action in group A was more (4.08±1.06 hours) than group B (2.18±1.24hours). Visual analogue score showed significant pain reduction in group A after 15 minutes and also at 180 minutes (p=0.000) in comparison with group B. femoral nerve block is safe, simple and more efficacious procedure in comparison toConclusion: systemic IV analgesia for acute pain management in patients with fracture shaft femur.

Management of femoral shaft fracture in children by using minimal invasive plate M.A.Mikhael, A.I.Ali and M.M.El Karmany

Management of femoral shaft fracture in children by using minimal invasive plate M.A.Mikhael, A.I.Ali and M.M.El Karmany

Prospective study on functional outcome of fracture shaft of femur (Winquest Hansen type 1, 2 and 3) treated with intramedullary interlocking nail

The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the functional outcome after antegrade intramedullary nailing of traumatic femoral shaft fractures. In a prospective study, patients with a femoral shaft fracture but no other injuries to the lower limbs or pelvis were included. A total of 40 patients met the inclusion criteria. All were operated by standard procedure of antegrade intramedullary interlocking nailing. Patients were reviewed at 1,3,6,12 months and we used KLAUSS & KLEMN CRITERIA and McNAIRS LOWER LIMB QUESTIONNARE for quantification of functional outcome. Mean age of such fractures was 24 years(+/- 5 years) majority being male and main mechanism of injury being RTA. There were 2 cases of fat embolism and 2 cases of superficial infection which healed by conservation method. Average time of radiological union was 12-24 weeks. There were no case of non-union but 1 case of delayed union for which dynamization was done.Final functional outcome came out to be good to excellent in all the patients.

Influence of a temporary stabilization device on respiratory status in patients with severe trauma with a femoral shaft fracture treated by damage control strategy.

BackgroundThere are few studies on the safety and respiratory consequences of the use of a skeletal traction (ST) device in the management of femoral shaft fractures with damage control orthopaedics (DCO) strategy, particularly in cases of prolonged use. The aim of this study was to assess the influence of ST compared with an external fixator (EF) on respiratory complications and mechanical ventilation requirements in patients with severe trauma with a femoral shaft fracture managed by DCO strategy.MethodsWe retrospectively reviewed all patients with severe trauma patients with a unilateral femoral shaft fracture admitted to our institution from 2010 to 2015. Patients who did not undergo definitive osteosynthesis during the first 24 h were included and divided into two groups: DCO-ST group and DCO-EF group. In addition to trauma severity, global management of respiratory complications, the incidence of acute respiratory distress syndrome (ARDS) and mechanical ventilation requirements and outcome were compared.ResultsFifty-five patients were managed with DCO strategy (mean Injury Severity Score, 28.4); there were 31 in the DCO-ST group and 24 in the DCO-EF group. No significant difference in terms of the main characteristics, initial severity and associated injuries was observed between the two groups. In contrast, ARDS was found more frequently in the DCO-ST group (81% versus 54%; P = 0.035). Number of ventilation days also tended to be higher in the DCO-ST group (9 days [IQR 3–15 days] versus 7 [IQR 2–16 days]; P = 0.24). No difference was found for mortality and hospitalization duration between the DCO-ST and DCO-EF groups.ConclusionThe prolonged use of an ST device in the present cohort was associated with a higher incidence of impaired respiratory function. Therefore, our findings suggest that EF is preferable to ST in the DCO setting for femoral shaft fracture, especially in trauma patients at high risk of developing delayed respiratory failure.

A Comparative Study of Management of Femoral Shaft Fracture in Children: A Prospective Study

Context: Femoral shaft fracture is the most common major pediatric orthopedic fractures and treatment of them carries a lot of controversies. Aims: The aim of this study was to compare the functional outcome after internal fixation with titanium elastic nail and stainless steel Kirschner wire in unstable femoral shaft fracture in children. Settings and Design: This prospective study was conducted at Sharda University between December 2010 and December 2017 and were followed up for 12 months. Materials and Methods: A total of hundred children between the ages of 2–14 years having closed unstable fracture of the femoral shaft were included in the present study. Fifty children were managed with titanium nails (Group 1) and the same number of children was managed with stainless steel Kirschner wires (K-wires) (Group 2). Functional outcomes were evaluated using the criteria of Flynn et al. Statistical Analysis Used: Statically analysis was limited to calculation of percentage of patients who had unions, malunions, delayed unions, or nonunions and excellent, good, and poor outcomes. Results: Based on the Flynn criteria, 92% of patients had excellent results, 8% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union, functional outcome, and complication. Conclusion: The clinic-radiological results were not significantly different between titanium nail and Kirschner wire at 1-year follow-up as observed by our study. The cost of Kirschner wire is one-third the cost of titanium nail.

Endovascular Treatment of Klippel-Trenaunay Syndrome

Endovascular Treatment of Klippel-Trenaunay Syndrome

(FLiP) fracture-table vs. lateral positioning for femoral intramedullary nailing: A survey of orthopaedic surgeon preferences

BackgroundFemoral shaft fractures are common and severe injuries that often occur alongside other complex, high-energy injuries. Definitive internal fixation using reamed, locked intramedullary nailing (IMN) has become the standard of care in adequately resuscitated patients, commonly performed in the supine position with utilization of a fracture table. The lateral position, without the use of traction, offers an alternative that may be associated with lower complication rates. Given the lack of high-quality evidence in the area, this study was designed to assess the attitudes, knowledge base and preferences of Orthopaedic surgeons regarding patient positioning during antegrade IMN of femoral shaft fractures. MethodsOrthopedic surgeon members of the AO North America, Canadian Orthopaedic Association and the Ontario Orthopaedic Association were invited to participate in a web-based survey addressing the management of femoral shaft fractures and the need for further research in this area. ResultsMost surgeons (56%) favored treating mid-shaft femur fractures in the supine position using a fracture table compared to supine/sloppy lateral (29%) or direct lateral (12%) with the leg free draped. Canadian surgeons showed a significantly higher preference for supine positioning with a fracture table when compared to their American colleagues. Academic and higher-level trauma center surgeons were more likely to prefer the sloppy lateral or direct lateral positioning with manual traction compared to community surgeons. The most commonly cited perceived barrier for utilizing the lateral position was expertise and lack of available assistants. Forty-five percent of respondents expressed interest in being involved in a randomized control trial comparing lateral positioning vs. supine with traction. ConclusionConsensus surrounding the positioning and utilization of traction in femoral shaft fractures is lacking. Given the perceived possible benefits and reduced complications using the lateral position and free-leg draping, further research is warranted to determine the optimal positioning for these injuries during femoral IMN. Level of EvidenceIV Study TypeCross-sectional Survey

Evaluation of outcome of titanium elastic nailing (TEN) versus hip spica cast in the treatment of femoral shaft fractures in children

Femoral shaft fractures are among the most common pediatric injury and treatment of them carries a lot of controversies. The aim of this study was to compare the outcome of titanium elastic nailing versus hip spica cast in femoral shaft fractures in children. This prospective study was conducted on 40 children of 5 to 15 years of age treated with titanium elastic nail or early hip spica cast for the fracture shaft of femur during July 2016 to October 2017 in the Department of Orthopaedics, R.I.M.S., Ranchi, Jharkhand. Majority of patients in both treatment group were male child with overall boy to girl ratio was 1.85:1. Mean age in titanium elastic nailing group was 9.82 ± 2.99 years and in spica group was 8.35 ± 2.53 years. RTA was most common mechanism of injury and right limb was more commonly involved in both groups. Union time was less in titanium elastic nailing group (8.80 1.76 week) than spica group (10.20 2.33 week) (p = 0.039). Patients in titanium elastic nailing group walked with and without support earlier than the spica cast group (p = 0.000). Most common complication in titanium elastic nailing group was limb lengthening (50%) followed by mal alignment (40%) while in spica group it was limb shortening (65%) followed by mal alignment (55%). Overall complication was higher in spica group. At final analysis, Flynn score was better in titanium elastic nailing group than in hip spica group (p = 0.365). Titanium elastic nailing is better method for the management of femoral shaft fractures in children as it results in higher rate of excellent functional outcome with lower incidence of complications.

Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study

BackgroundMalrotation of the femur is a frequent complication in the management of a diaphyseal fracture. It is often responsible for pain and adverse functional results. Among these complications, contact stress effects on the patellofemoral joint are recognized as predictive factors of impaired results. The purpose of this study was to analyze the effect of malrotation on stress distribution on the patellofemoral joint, using radiological measurement and three-dimensional finite element models. MethodsFunctional analysis of the patellofemoral joint was evaluated in eight knee pairs from patients with unilateral femoral fractures and subsequent femoral malrotation. A computed tomography-based protocol allowed patellofemoral joint analysis. A finite element model of the healthy (contralateral) knee was then created from 3D reconstruction at 30° flexion. In a finite element model, incremental rotational malalignment was simulated to observe changes in stress distribution on the patellar surface. ResultsFemoral malrotation was associated with anomalies of patellofemoral joint rotational alignment. Internal rotation resulted in increased stress on the lateral side of the patella, and external rotation increased inferior medial side stress. ConclusionsRotational disorders of the distal femur resulted in increased stress on the patellofemoral joint and alignment changes. Malrotation in internal and external rotation might cause patellofemoral pain syndrome from rotations <10°. Care should be taken especially for internal malrotation in the management of femoral shaft fracture.

Titanium Elastic Nails Versus Spica Cast in Pediatric Femoral Shaft Fractures: A Systematic Review and Meta-analysis of 1012 Patients.

There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some evidence, nonetheless, we undertook a systematic meta-analysis to assess the efficacy of TEN compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old. A computer literature search of PubMed, Scopus, Web of Science, CINAHL and Cochrane Central was conducted using relevant keywords. We included clinical trials and observational studies that compared TEN versus Spica cast; Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search found 573 unique articles. After screening the abstract and relevant full text, 12 studies with a total of 1012 patients were suitable for the final analysis. In terms terms of union (in weeks), the reported effect sizes favoured the TEN group in two included studies only. Moreover, the overall standardized mean difference in sagittal (SMD -0.48, 95% CI [-0.70 to -0.26], P<0.001) and coronal angulations (SMD -0.66, 95% CI [-1.00 to -0.31], P<0.001) favored TEN fixation in management of femoral fractures younger than 16 years. The reported length of hospital stay was not consistent across studies. The overall risk ratio of malalignment (RR=0.39, 95% CI [0.27 to 0.57], P<0.001) favored the TEN as well as walking independently. Based on our analysis, TEN treatment is superior to traction and hip spica for femoral fractures in patients younger than 16 years old. Based on our analysis we recommend the use of TEN fixation in management of pediatric femoral fractures in patients younger than 16 years.

Elastic Stable Intramedullary Nailing of Femoral Shaft Fracture-Experience in 48 Children.

Femoral shaft fractures are an incapacitating pediatric injury accounting for 1.6% of all pediatric bony injuries. Management of these fractures is largely directed by age, fracture pattern, associated injuries, built of the child and socioeconomic status of the family. We retrospectively evaluated the use of elastic stable intramedullary nail (ESIN) in surgical management of femoral shaft fractures in children and its complications. Fifty two children were treated with titanium elastic nails (TEN) from June 2009 to June 2014 at our institution. At the end of the study there were 48 children. Fractures were classified according to Winquest and Hansen's as Grade I (n=32), Grade II (n=10), Grade III (n=6) and compound fractures by Gustilo and Anderson's classification, Grade I (n=5), Grade II (n=3). There were 36 mid-shaft fractures, 7 proximal third shaft fractures, 5 distal third shaft fractures. The final results were clinically evaluated by using Flynn's criteria and radiologically by Anthony et al's criteria. The mean duration of follow-up was 20 months (range 12 - 40 months). All fractures healed radiologically with grade III callus formation at 9 - 12 weeks (mean 9.7 weeks). The results were analyzed using Flynn's criteria and were excellent in 40 children (83%) and satisfactory in 8 children (17%). The soft tissue discomfort near the knee produced by nail ends was the most common problem in our study (25%). Other complications include limb shortening (n=5), Varus malunion (n=4), Nail protruding site infection (n=4) and nail migration (n=2). There was no delayed union, non-union or refractures. TEN is minimally invasive, safe, relatively easy to use and an effective treatment for fracture shaft of femur in properly selected children.Level of evidence: III.

Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study

ABSTRACTPurpose: Intramedullary nailing (IMN) is a popular method in the management of femoral shaft fractures (FSFs). However, whether the association of IMN with pulmonary fat emboli can compromise the pulmonary and nervous systems is debatable. The purpose of this study is to compare IMN with the locked dual plating (LDP) method by assessing the clinical outcomes of FSF patients with head or chest injury. Method: A total of 126 FSF patients were included in this study between January 2010 and July 2016 and divided into LDP and IMN groups. Patient demographic characteristics, operative time, blood loss, Harris Hip Score, Lysholm Knee Score, radiological outcomes, and systemic complications were collected and compared between the two treatment groups. Patients were followed up for at least 12 months. Results: The LDP group performed better than IMN in terms of operative time, estimated blood loss amount, and malunion rate. Differences in function scores, fracture union rate, overall pulmonary complication rate, and in-hospital mortality between the two groups were not significant. Average radiographic union time was significantly longer in the LDP group (36.3 weeks) than in the IMN group (32.5 weeks). One case of fixation failure occurred postoperatively in the LDP group, whereas one case of fracture nonunion took place in the IMN group. Conclusion: Our findings suggest that dual-plating fixation is a promising method for FSFs with multiple injuries. However, the retrospective nature of this study necessitates high-quality trials to be performed to assess the clinical efficiency of dual plating.

The role of computed tomography scans in diaphyseal femur fractures following gunshot injuries: A survey of orthopaedic traumatologists

The objective of this study was to analyze if the addition of CT changed the management of femoral shaft fractures caused by gunshot wounds when compared to those managed with plain radiography alone. MethodsA multiple-choice, single-answer electronic survey was created to compare utility of advanced imaging when treating femur fractures resulting from gunshot injury. A total of ten femoral shaft fracture cause by gunshot injuries were selected for an online survey to be administered to orthopeaedic traumatologists. The survey compared the use the of fixation device and surgical planning before and after the CT scan. ResultsA total of 99 surveys were initiated, of which 82 were completed. For proximal shaft fractures, 37% of experts reported that a CT scan should be ordered based on the radiograph alone, prior to reviewing the CT. After reviewing the CT, 5% of experts reported that they would have performed a “major” change, and 10% reported that they would have performed a “minor” change. 4% of surveyors would have changed their decision regarding ordering a CT. For distal femoral shaft fractures, 42% of experts selected that a CT scan would have been ordered prior to reviewing the CT. After reviewing the CT, 2% would have performed a “major” change, and 8% would have performed a “minor” change in management. 5% of surveyors would have changed their decision regarding ordering a CT. ConclusionOur study demonstrated that CT scans are relatively unlikely to cause major changes in fracture management of gunshot-induced fractures of femoral shaft.

Novel technique to accurately measure femoral diameter using a Thomas splint

IntroductionDuring surgical management of femoral shaft fractures, difficulties arise when treating patients with narrow femoral diaphyseal canals, such as young patients and those with dysplastic femurs secondary to underlying pathology. Accurate pre-operative assessment of the femoral diaphyseal canal diameter would allow the surgeon to plan surgical technique and ensure appropriate equipment was available, such as narrow, unreamed or paediatric sized nails. TechniqueWhen secured to the patient both longitudinal rods of the main Thomas Splint component lie parallel with the femoral shaft and horizontal to the radiographic x-ray plate. The diameter of these rods are 13mm (Adult and paediatric). Using the calibration tool, we calibrate the diameter of the Thomas Splint to 13mm, accurately measuring any further detail on that radiograph, such as the diaphyseal canal diameter. ConclusionAccurate knowledge pre-operatively of radiographic measurements is highly valuable to the operating surgeon. This technique can accurately measure femoral canal diameter using the Thomas splint, negates the requirement for a calibration marker, is reproducible, easy to perform, and is indispensible when faced with a patient with a narrow femoral canal in a diaphyseal femoral fracture. (181 words)

TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children.&#x0D; Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures.&#x0D; Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks).&#x0D; Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

Randomized control trial comparing primary hip spica versus initial traction and hip spica of fracture at or below the junction of the upper and middle third of femur in children

Background: The debate regarding optimal management of femoral shaft fractures in the pediatric population is still far from resolved. While some consensus exists in the treatment of this injury in children younger than the age of six, opinion still widely divided in children six to 11 years.Objective: The aim of study was to compare the outcome of primary hip spica versus initial traction and hip spica of fracture of shaft of femur at or below the junction of the upper and middle third in children in terms of deformity and fracture healing.Method: A RCT study was carried out in the departments of Orthopedics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal from March 2004 to January 2006. Forty five patients were included in the study in which 22 patients included in early spica casting (group I) and 23 patients in traction with spica casting (group II). The functional outcomes were assessed with Pearson’ Chi-square test, Independent samples test and union was assessed radiologically.Result: There was no statistically significant difference in time of union; all of them united in 8-10 weeks follow up. No significant overall difference in terms of deformity was noted in the two groups(p value-0.306).There was significant difference in terms of hospital stay in both the groups(p value&lt;0.05).Conclusion: The study showed that there is significant advantage in primary hip spica cast for the treatment of isolated , closed femur fractures in children ages less than 10 years and weight less than 80 pounds(45kg) which allowed us to treat these fractures without any worry of wound dehiscence, pin site infections, avascular necrosis of the femoral head.Health Renaissance 2015;13(2): 80-91