Outcome Of Proximal Femoral Nail Research Articles

Evaluation of the outcome of proximal femoral nail in the treatment of unstable Intertrochanteric fracture in adult

Background & Objectives: The incidence of intertrochanteric fractures among elderly patients is expected to be increased even further with the advancing age of the population, proximal femoral nail was introduced as a method of treatment for this fracture, which is currently the most effective surgical method. The goal is to find out the role of a proximal femoral nail in treating intertrochanteric fractures and assess the advantages and complications of this treatment method. Methods: This prospective study was conducted on seventy patients with unstable intertrochanteric fractures treated with Proximal femoral nails at Erbil teaching hospital. They were followed up for one year, from (May 2016 to May 2017). Patients were examined for the union of fracture and complications clinically and radiologically. The functional outcome was evaluated using the Harris Hip Score. Results: Total number of 70 patients were included in this study, 44 (62.85%) were females, and 26 (37.15%) were males. The mean operative time was (90.885 min. ±11.38SD). Infection developed in (1.42%) of the patients. The most common complication was Varus malalignment which was found in (5.7%) of the cases. Harris Hip Score-based findings were excellent-good in (85.7%) of patients Conclusion: Proximal femoral nail is a relatively effective treatment possibility for most unstable intertrochanteric fractures with good biological stabilization, better short-term outcomes, and minimal complications.

Functional outcome of proximal femoral nailing in subtrochanteric fracture of femur in adults

Functional outcome of proximal femoral nailing in subtrochanteric fracture of femur in adults

Outcome of buttress plate-nail construct used for reconstruction of broken lateral wall in intertrochanteric fractures

PurposeIntramedullary implants are well accepted fixation of all types of intertrochanteric (IT) fractures, both stable and unstable types. Intramedullary nails have an ability to effectively support the posteromedial part, but fail to buttress the broken lateral wall requiring lateral augmentation. The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures, which was fixed to the femur through hip screw and anti-rotation screw nail. MethodsOf 30 patients, 20 had Jensen-Evan type III and 10 had type V fractures. Patients with IT fracture of broken lateral wall and aged more than 18 years, in whom satisfactory reduction was achieved by closed methods, were included in the study. Patients with pathologic or open fractures, polytrauma, prior hip surgery, non-ambulatory prior to surgery, and those who refused to participate were excluded. The operative time, blood loss, radiation exposure, quality of reduction, functional outcome, and union time were evaluated. All data were coded and recorded in Microsoft Excel spread sheet program. SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test. ResultsThe mean age of patients in the study was 60.3 years. The mean duration of surgery (min), mean intra-operative blood loss (mL) and mean number of exposures were 91.86 ± 12.8 (range 70 – 122), 144.8 ± 3.6 (range 116 – 208), and 56.6 (range 38 – 112), respectively. The mean union time was 11.6 weeks and the mean Harris hip score was 94.1. ConclusionLateral trochanteric wall in IT fractures is significantly important, and needs to be reconstructed adequately. Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment, fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.

Comparison of the Radiological and Functional Outcome of Proximal Femoral Nail with Helical Blade versus Lag Screw in Intertrochanteric Fractures

Introduction: Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. These fractures occur both in the elderly and the young, but they are more common in the elderly population with osteoporosis due to a low energy mechanism. The female to male ration is between 2:1 and 8:1. Operative management of these fractures is considered urgent, not emergent. This allows the many comorbidities with which patients often present to be optimized preoperatively, to reduce morbidity and mortality.

A narrative review on functional outcome of intertrochanteric fractures treated with proximal femoral nailing

Introduction: Intertrochanteric fractures are the prevalent fractures in the elderly individual. Due to the unsteady design showed to be exigent demand to manage. The main aim of this study is to review the management modalities of intertrochanteric fractures and the outcome following proximal femoral nailing as reported in the literature.Methods: Articles involving the intertrochanteric fractures and proximal femoral nailing were collected from various sources, including PubMed, Google Scholar, open-access journals excluding review articles, small studies and case reports. The modalities of treatment and outcome of proximal femoral nailing was reviewed. Results: Early fixation and early mobilization of the patients is the mainstay goal in the treatment of intertrochanteric fractures. Intramedullary devices (PFN) offer better fixation of complex patterns of fractures and aid in early weight-bearing compared to extra-medullary devices and hence is the preferred mode of fixation.

Functional Outcome of Proximal Femoral Nailing in Intertrochanteric Fracture.

Intertrochanteric fracture of femur is one of the commonest fracture seen in elderly, osteoporotic female. The main stay of treatment is fixation with dynamic hip screw or intramedullary device like Proximal Femoral Nail. Intramedullary devices are found to be more biomechanically advantageous. The functional outcome of these fractures depends on the type of fixation, age and stability of fracture. The objective of this study is to assess the functional outcome of Proximal Femoral Nail in intertrochanteric fracture. An observational study was conducted in Kathmandu Medical College, Sinamangal from January 2018 to May 2019. 32 patients with intertrochanteric fracture were treated with proximal femoral nail during this period. The functional outcome was measured at 6 weeks, 12 weeks and 6 months using Harris hip score. There were 46.9% males and 53.1% females with mean age of 71.09 ±12.35 years. Most of the patients sustained injury after falling from standing height (53.1%). The functional outcome measured at final follow up (6 months) with Harris hip score was good in 62.5% and excellent in 28.1% patients likewise follow up in 12 weeks was good in 15.6%. Proximal Femoral Nail in trochanteric fractures seem to provide a good functional outcome at 6 months follow up. This technique, therefore appears to be a viable option in the management of intertrochanteric fracture of femur.

Functional Outcome in Intertrochanteric Femur Fracture Fixation using Proximal Femur Nail

Background: This study was conducted to assess the functional outcome of Proximal Femoral Nailing in fixation of Intertrochanteric fractures of Femur. Methods: After obtaining written consent, this prospective study was conducted among 127 patients (age group>18 years) who had inter-trochanteric fracture with or without subtrochanteric extension fixed using proximal femoral nail. Mobilisation was started between first week to 6th week of fracture fixation depending on the rigidity of fixation and pain tolerance of the patient. Patients were followed up at 6th week, 3rd month and 6th month after operative fixation. Functional outcome was assessed using a physician based scoring system i.e. Harris Hip Score at every follow up. Scores were tabulated and assessment was done. Results: The present study included, 54 females (42.5%) and 73 males (57.5%) in the age group of 28 years to 94 years with the mean age of 67.7 years. Unstable inter-trochanteric fractures were seen in 106 cases (83.5%) ‘Fair’ results were seen in 17(13.4%), ‘Good’ results seen in 61(48.0%), ‘Excellent’ results were seen in 37(29.1%) patients at the end of 6 months follow up. Intraoperative complications were seen in 4 patients and late complications seen in 13 patients. Conclusion: From this study, we consider that PFN is an excellent implant for the treatment of intertrochanteric fractures. With a proper technique, PFN gives excellent clinical results with fewer failure rates and complications.

The Outcome of Proximal Femoral Nailing in Adults Treated for Subtrochanteric Femur Fractures. A Longitudinal Study

Aim: To assess the outcome of proximal femoral nailing (PFN) in adults treated for subtrochanteric femur fractures. Study design: A longitudinal study Place and Duration: This study was conducted at Muhammad Medical College and Hospital Mirpurkhas, Pakistan from June 2020 to May 2021. Methodology: In this study prior to surgery, all patients were immobilised. Before installation and wrapping, the other extremity rotation and length measurements were determined. Closed reduction was implemented along with the internal fixation. The Harris Hip Score was utilised to assess the postoperative outcomes. SPSS version 21 was used for data analysis. Results: In this study, 30 patients were included; 66.66 % (n=20) were males, the majority were 31-50 years old, and the average hospitalisation time was 15.55 days. Except for three patients, all of the others could move around unassisted after five months. According to the Harris Hip Score, 16.66% (n=5) of patients had exceptional outcomes, 20% (n=4) had good outcomes, and 63.33% (n=19) had fair results. Conclusion: PFN is a fantastic implant for femoral ST fractures. The benefits include reduced exposure (closed approach), increased stability, and earlier deployment. Keywords: Proximal Femoral Nailing, Sub Trochanteric, femur fractures, Harris Hip Score

Comparative analysis of functional and radiological outcome of proximal femoral nail versus dynamic hip screw in treatment of intertrochanteric fractures

Comparative analysis of functional and radiological outcome of proximal femoral nail versus dynamic hip screw in treatment of intertrochanteric fractures

Functional outcome of proximal femoral nailing in intertrochanteric fractures: A prospective study

Background: The study was conducted to assess clinical and functional outcome of Proximal Femoral nailing in intertrochanteric fractures and to determine the rate of union, complications, operative risks and co morbidities associated with intertrochanteric fractures.Intertrochanteric fractures form around half of the total hip fractures in the elderly and pose a number of management dilemmas depending on the fracture configuration and status of the bones. There are numerous implants available for the internal fixation of these fractures ranging from dynamic hip screw which can be combined with trochanteric stabilisation plate; locking plates; intramedullary implants such as proximal femoral nail (PFN), trochanteric femoral nail (TFN) and Gamma nail.Materials and Methods: The fractures were classified according to BOYD and GRIFFIN classification system. 40 patients of intertrochanteric fractures fulfilling the inclusion and exclusion criteria, were managed surgically using Proximal Femoral Nail. The results were analyzed according to age, type of fracture, operative details and functional outcome using KYLE’s criteria.Results: Totally 40 patients with intertrochanteric fractures were operated with PFN and were included in the study. The mean age of the patients was around 68 years with minimum age being 52 years and the maximum being 88 years. The mean duration of operation was recorded to be 54.59 min. Complications in this study were seen in 3 patients (8%). Complication was surgical site infection 2 patients (5%), greater trochanteric fracture 1 patient (2.5%).Conclusion: The proximal femoral nail acts as a buttress to prevent medialisation of the shaft & provides more effective load transfer. It has a chance of failure in the comminuted and severely osteoporotic fractures. It is superior implant for both stable & unstable fractures. It also has advantages of having decreased blood loss, decreased operating time, decreased complication rates.

A comparative study of functional outcome of proximal femoral nailing and bipolar hemiarthroplasty in unstable basicervical fracture neck of femur in age >45 years

Background: A basicervical femoral neck fracture, which is located at the junction between the femoral neck and intertrochanteric region, is a rare type of fracture. (1) Despite several randomized trials and comparative studies treatment of unstable basicervical fractures in elderly patients is still controversial, which we want to investigate. Methods: A prospective cohort analysis of 44 patients, of which 22 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2018 till July 2021 was done. Primary outcome was assessed in both groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary outcome measures were intraoperative blood loss, surgical time, functional outcome, range of motion limb length discrepancy at final follow up. All complications were noted at follow up.Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 79.81 for BPA and 73.18 for PFN (p-value = 0.001) and at 1 year of follow up was 88.55 for BPA and 79.03 for PFN (p-value = 0.001). Statistically significant differences were found between BPA and PFN groups with reference to intraoperative blood loss, surgical time, functional outcome, range of motion, limb length discrepancy at final follow up.Conclusion: The bipolar hemiarthroplasty group had fewer complications and earlier mobilization with better Harris hip score at all follow ups, which indicate bipolar hemiarthroplasty is a better option in the treatment of unstable basicervical fractures in elderly patients.

Functional outcome of proximal femoral nailing (PFN) versus dimon hughston osteotomy with dynamic hip screw (DHS) fixation in unstable intertrochanteric femur fractures

Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low energy trauma like simple falls. The goal of the treatment of these fractures is stable fixation, which allows early mobilization of the patient. This study was conducted to compare the functional and radiological outcome of proximal femoral nailing and Dimon Hughston Osteotomy with Dynamic Hip Screw (DHS) fixation in treatment of unstable intertrochanteric femur fractures amongst 60 patients, with 30 patients in each group. In our study we found that patients treated with DHS group showed better results in comparing PFN in terms of early weight bearing, functional outcome, early radiological union but had its own complications. Both are effective in the treatment of unstable intertrochanteric fractures, it is the fracture geometry and bone quality which will influence the choice of fixation.

A study on functional and radiological outcome of proximal femoral nailing

The proximal femoral nail, in titanium or steel and for left and right use, consists of a 240 mm long nail, the distal part of which is available in 10, 11 or 12 mm diameter. The proximal part measures 17 mm in diameter. The angle between both parts is 6 to 8 degrees, situated at 11 cm distally from the top of the nail. All patients were classified based on AO system of classification for intertrochanteric fractures. AO system was used because it needed only AP view of the pelvis. Standard preoperative evaluation was be followed with complete assessment by anesthetist. Routine institutional protocol was followed for preoperative preparation and surgery. According to the American society of Anaesthesiologists classification (ASA) majority of our patients (35) belonged to ASA grade 3. Intertrochanteric fractures are classified according to AO classification in our study. AO 2.2 was the most common type of fracture.

Functional outcome of proximal femoral nailing for unstable intertrochanteric fracture in elderly

<p class="abstract"><strong>Background:</strong> This study is intended to analyse the functional outcome of proximal femoral nailing (PFN) for unstable intertrochanteric fractures in elderly.</p><p class="abstract"><strong>Methods:</strong> The data was collected from the 35 patients with unstable intertrochanteric femur fracture who were subjected to PFN from 2015 to 2018. All patients were followed up at 3 months and 6 months after the operation to check the functional outcome based on harris hip score (HHS) and complication if any.</p><p class="abstract"><strong>Result:</strong> In 35 patients, 1 patient was lost to follow-up and 34 patients were followed-up at 3 months and 6 months. All patient’s union was achieved at 3 and 6 months follow up. The cause of fractures was trivial fall in all 35 patients. No incidence of non-union and delayed union was reported. Functional outcome was rated as per HHS, we got excellent results in 20 cases, good in 10, fair in 03 and poor in one patient at end of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> PFN provides stable fixation and early post-operative mobilization with fracture union especially complex proximal femoral fractures which includes unstable, communited, reverse oblique fractures and fractures in osteoporotic bones. PFN has shown excellent results in our study.</p>

Functional outcome trochanteric fracture treated with proximal femoral nail

Introduction: proximal femoral nail is widely using implant in treatment of trochanteric fracture of femur. Various study has been done of functional outcome of PFN. The aim of study to know the functional outcome of proximal femoral nailing in trochanteric fracture. Material and Method: The study was done in rajshree medical college and hospital during period of 8 month. Fracture classification according to AO the functional outcome evaluated by the harris hip score. Result: 40 patients of either sex with trochanteric fracture were studied up to 8 month. The largest age group of patient was 51 to 60 year. Young patient due to road traffic accident. Male are more than female. Reduction achieved in traction table by closed method in which failed open reduction done. The complication rate was around 20%.the fictional outcome by Harris hip score excellent in 22 pt. Conclusion: Proximal femoral nail is technically demanding implant. With proper method it’s give excellent results.

Analysis of factors affecting the radiological and functional outcome of proximal femoral nailing in unstable intertrochanteric fractures

Introduction: The incidence of hip fracture continues to increase as the elderly population increases, as a result of the extension of the average life span. Intertrochanteric fractures have been treated successfully by various methods, and now we are in an era where functional rehabilitation of patients to their preinjury levels is of prime importance. Reconstruction-type proximal femoral nailing is one of the surgical techniques used to treat intertrochanteric fractures. This implant faces less criticism than the previous ones, but it also has its own disadvantages. Aim: To analyze the factors that affect the functional and radiological outcomes of unstable intertrochanteric fractures treated by proximal femoral nailing and to identify the factors responsible for an abnormal gait pattern after union in some patients. Materials and Method: Forty-two patients treated in our facility who were categorized as having unstable intertrochanteric fractures were followed up until radiological union was achieved and 16 patients who had abnormal gait patterns were further studied to find the factor responsible. Tip­ Apex Distance, lateral screw sliding/collapse, screw position in the neck, initial and final neck-shaft angles, quality of reduction by the modified Fogagnolo et al. criteria and functional outcomes based on Harris Hip Score were analyzed. Results: The average Harris Hip Score in our study was 83.8. Thirty-eight patients did not have any complications, but 16 our patients had abnormal gait patterns at the final follow-up. The reason for the abnormal gait pattern was secondary varus collapse caused by excessive lag screw sliding. Conclusion: The initial quality of reduction as recommended by Fogagnolo is the key factor to achieve a favorable outcome. Proximal femoral nail helps in early return to their preinjury status in most of the patients. It also prevents the varus collapse in unstable intertrochanteric fractures, given the screws are positioned ideally.

Proximal femur nail vs cemented bipolar prosthesis in unstable intertrochanteric femur fractures in elderly: A prospective study

Background: Surgical stabilization of Intertrochanteric fracture femur is one of the most commonly performed orthopaedic procedures. Present study was done to analyse the outcome of various treatment modalities for unstable Intertrochanteric fracture femur in elderly. Methods: The present clinical study was carried out at our tertiary care hospital. Study duration was from Jan 2015 to June 2016. 70 patients over the age of 60 years with unstable Intertrochanteric fracture were selected. Outcome of management of unstable Intertrochanteric fracture femur was analysed using Harris Hip Score in Proximal femoral nail (PFN) and Cemented Bipolar prosthesis (CBP). Results: Most of the patients were between 60-70 years of age. The average age of study group was 68.9 years. 35 patients treated with PFN and 35 patients treated with CBP. Superficial infection was seen in 4 patients and was the most common complication found in cemented bipolar prosthesis. External rotation deformity was second most common complication seen in 5 patients. Out of them, 2 patients were of CBP and 3 patients of PFN. Deep wound infection occurred in 1 case of CBP. Average blood loss in patients operated with PFN and CBP were 205 ml and 311ml in CBP. It was noted that shorter time was required for P.F.N (55 min) and then for CBP (84min). Average Harris score for PFN and CBP at 3 months, at 1 year and at 2 years were 70.1:74.9, 86.4:78.2 and 84.4:76.6. Conclusion: Considering the amount of blood loss, duration of the surgery and Harris Hip Score, PFN is better for unstable inter trochanteric fracture femur than CBP. The only advantage of Hemiarthroplasty was early weight bearing. But at the end of 1 year and 2 years, the outcome of PFN was better than Cemented Bipolar prostheses. Statistical method: Data were reported as mean, median (range) or number. t-test was used to assess significant difference among all numerical parameters of the study within the two surgical groups. P–values < 0.05 were considered statistically significant.

Analysis of outcome of proximal femoral nailing in unstable trochanteric fractures: A prospective study

Inter-trochanteric fractures are the common fractures of hip which occurs in young adults as a result of high velocity injury and in osteoporotic elderly due to low velocity injury. Inter-trochanteric fractures are treated by various surgical modalities. Proximal femoral nailing is now been used widely for the treatment of unstable inter-trochanteric fractures. The clinical and radiological outcomes are good with low rates of complications. We prospectively studied 36 unstable inter-trochanteric fractures treated with proximal femoral nailing. The overall functional result was assessed by the Harris Hip Score which was Excellent in 13.34%, Good in 41.67%, Fair in 19.44% and Poor only in 5.55%.

Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population ? A prospective randomized study

IntroductionIntertrochanteric fracture is one of the most common and severe fractures occurring in the elderly population. We conducted a randomized prospective study to compare the functional and radiological outcome of Proximal Femoral Nail anti-rotation-Asia(PFNA-II) and Dynamic Hip screw (DHS) used in fixation of stable (AO type 31 A1-A2.1) intertrochanteric fractures in elderly. Methods60 elderly patients with stable intertrochanteric fractures treated with DHS and PFNA-II between August 2014 to Dec 2016 were enrolled in the study. Intraoperative variables-surgical time, blood loss, fluoroscopy time and post-operative variables-union rate, change in neck shaft angle(NSA), functional outcome in terms of Modified Harris Hip Score(HHS) & SF-12, complication rate and mortality at one year were studied and compared between both the groups. ResultsThe mean age of patients in our study was 70.96 years. We found patients treated with DHS required significantly longer surgical time and had more blood loss compared to PFNA-II group. However, there was no significant difference in both the groups in terms of intra-operative fluoroscopy time, change in neck shaft angle, union rate, complication rate and Modified Harris Hip Score & SF-12 at three months; six months and one year follow-up. ConclusionsBoth DHS and PFNA-II can be used effectively in the treatment of elderly patients with stable intertrochanteric fracture with comparable outcome. However, in high-risk elderly patients requiring shorter surgical time and less blood loss, PFNA-II can be used.

Assessment of the Complication and Radiological Outcome of Proximal Femoral Nailing in Unstable Trochanteric Fractures

Assessment of the Complication and Radiological Outcome of Proximal Femoral Nailing in Unstable Trochanteric Fractures