Outcome Of Unstable Intertrochanteric Fractures Research Articles

A study of functional outcome in unstable intertrochanteric fractures treated by proximal femoral nailing in Bundelkhand region

Background: Intertrochanteric fractures are the most frequent fractures of the hip joint. This is attributed to the increase in the elderly population in our country, along with osteoporosis being prevalent in these populations. Aims and Objectives: The aim of the study is to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with “proximal femoral nail” (PFN). Materials and Methods: The prospective study was conducted on 48 cases of unstable intertrochanteric in Maharani Laxmi Bai Medical College, Jhansi, between June 2022 and December 2023. Results: In our study, the mean age of the patient is 36.16 and the most common age group is 41–60 years, 33.33%, and >60 years, 41.67%. In forty-eight cases, 37 (77.08%) were male patients, and 11 (22.92%) were female patients. The Harris hip score patients follow-up after 3 months 8 (16.67%) patients of excellent outcomes, 18 (37.50%) patients of good outcomes, 12 (25.00%) of fair outcomes, and 10 (20.83%) patients of poor outcomes. The Harris hip score patients follow-up after 6 months 24 (50%) patients of excellent outcomes, 20 (41.67%) patients of good outcomes, 2 (4.17%) of fair outcomes, and 2 (4.17%) patients of poor outcomes. Conclusion: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation, and early return to work.

Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain

Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain

Functional outcome of unstable intertrochanteric fracture treated with long PFN with or without augmentation

Functional outcome of unstable intertrochanteric fracture treated with long PFN with or without augmentation

Functional Outcome of Unstable Intertrochanteric fracture Treated with Proximal Femoral Nail Anti-Rotation

Background: Intertrochanteric fractures are one of the most disabling injuries, most commonly observed among the elderly, and shows a challenging problem for orthopedic surgeons. Nowadays, intertrochanteric fractures are being treated with different extramedullary and intramedullary devices. Among them, intramedullary fixations show the best outcome, and are widely used for different treatment of unstable intertrochanteric fractures (type 31A2, 31A3). A new device designed by AO/ASIF, the Proximal Femoral Nail Anti-Rotation (PFNA) represents a unique intramedullary nail system for improved management, with decrease in the number of complications. Material Methods: This prospective hospital based clinical trial was conducted at the Department of Orthopaedic Surgery, Chittagong Medical College Hospital, Chattogram, Bangladesh. The study duration was 2 years, from January 2018 to December 2019. During this period, a total of 48 patients who were admitted in the study place with unstable intertrochanteric fracture of femur were included in the study. Patients were followed up for 24 weeks, and overall outcome was measured using Kyle’s Criteria. Results: 48 patients were treated for unstable intertrochanteric fractures. The majority were between 50-80 years old (62.5%), with a mean age of 58.38. Gender distribution was even, with 50% male and 50% female. 75% of fractures were caused by a fall from height and 25% by a road traffic accident. 68.75% of fractures were type 31A3 and 31.25% were type 31A2. 68.75% of patients did not have comorbidities. The mean time interval for fixation was 12.6 days, and the majority of operations lasted between 45-90 minutes. 87.5% had a closed reduction and 12.5% had an open reduction. 64.58% of patients had radiation time between 2.5-3.3 minutes. At 2 weeks follow-up, 21.28% had poor functional outcome, 78.72% had fair functional outcome, and none had good or excellent outcomes. At 6 months follow-up, 2.17% had poor outcomes, 8.70% had fair outcomes, 34.78% had good outcomes, and 54.35% had excellent outcomes. 16.67% of patients experienced complications such as infection, varus, delayed union, and lateral migration. Conclusion: Most patients achieved good to excellent functional outcomes after treatment, with minimal complications.

Outcome of treatment of Unstable Intertrochanteric Fracture by Proximal Femoral Nail (PFN)

Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral fractures.

Comparative study on functional outcome of unstable intertrochanteric fractures treated with bipolar hemiarthroplasty and dynamic hip screw fixation in elderly population

Comparative study on functional outcome of unstable intertrochanteric fractures treated with bipolar hemiarthroplasty and dynamic hip screw fixation in elderly population

Outcome of unstable intertrochanteric fractures managed with Proximal Femoral Nail Anti-rotation-II: A study in elderly Nepalese population.

Introduction: The ideal implant for treating unstable intertrochanteric fracture has been controversial. Studies have shown good results with various intra-medullary nails. Likewise, Proximal Femoral Anti-rotation-II (PFNA-II) has been designed for the Asian population. But the knowledge about the outcomes of PFNA II in our particular region has been lacking. Objectives : To evaluate the radiological and functional outcome of unstable intertrochanteric fractures in elderly patients managed with PFNA-II. Methodology: This is a prospective clinical study conducted at Nobel Medical College between February 2019 and March 2021. Patients above 65 years of age with unilateral unstable intertrochanteric fracture were managed with PFNA-II. Radiological union and complications were recorded. Functional outcome was assessed on the basis of modified Harris Hip Score. Results: Twenty-nine patients were included in the final evaluation and had at least one year follow-up. Two patients (6.8%) had superficial infection. The average Tip Apex Distance (TAD) was 22.28 mm (range, 18- 28 mm). Mean modified Harris Hip Score at one year was 82.59 with good outcome in 23(79.3%) patients. Conclusion: This study showed that good clinical outcome can be obtained when radiological parameters are restored. Good intra-operative fracture reduction, and optimal positioning and length of helical blade are crucial. We believe that PFNA-II is an excellent implant to treat unstable intertrochanteric fractures in elderly patients.

AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

Comparative study of extramedullary versus intramedullary fixation for unstable Intertrochanteric femur fracture

Context: Most frequent fractures of proximal femur are intertrochanteric fractures which involve upper end of femur between both trochanters with or without extending into the upper femoral shaft occuring commonly in geriatric patients. Unstable contribute to about 50%-60% of all intertrochanteric fractures. Aims: Though intertrochanteric fractures unite without surgical intervention, malunion with coxa vara deformity occur with conservative management. The aim of fixation of intertrochanteric fractures is to prevent morbidity and mortality. With this aim of stable surgical reconstruct of intertrochanteric fracture this study was done to evaluate functional, clinical and radiological outcome of unstable intertrochanteric fracture operated with dynamic hip screw with trochanteric stabilization plate (extra meduary fixation) and proximal femoral nailing (intramedullary fixation) and study epidemiology and demographics of intertrochanteric femur fractures in Indian scenario. Settings and Design: Methods and Material: The study was conducted at New Civil Hospital Surat. 50 patients with unstable intertrochanteric femur fractures admitted between february 2018 to march 2019. Conclusions: In this study we found that both-extra-medullary or intramedullary fixation were able to provide good clinical result for unstable Intertrochanteric femur fracture. We conclude that there is statistically significant difference between patients operated with DHS with TSP (Extra medullary implant) and Proximal Femoral Nail (Intramedullary implant) in terms of Blood loss, Mean operative time and functional outcome. Harris hip score in patients treated with PFN had better Harris hip score at final follow up which was statistically significant. All patients in both groups had bony union at final follow up. Blood loss and duration of surgery was significantly less with intramedullary Implant.

Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

<p class="abstract"><strong>Background:</strong> Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.</p><p class="abstract"><strong>Methods:</strong> We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month. Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.</p><p class="abstract"><strong>Conclusions:</strong> PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.</p>

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II

Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60 to 50. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome.Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

Factors Affecting the Outcome of Unstable Intertrochanteric Fractures Managed With Proximal Femoral Nail Anti-Rotation 2: A Prospective Outcome Study in Elderly Indian Population

BackgroundThe proximal femoral nail anti-rotation Asia (PFNA 2) is an implant designed for unstable osteoporotic intertrochanteric fractures in Asians as the PFNA was designed for Caucasians and had various complications when applied to the Asian population due to the femoral geometrical mismatch. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population.MethodsSixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with PFNA 2 were included in this prospective observational study. They were followed up for one year. The functional and radiographic evaluations were done at 6, 12, 20 weeks, and the functional outcome was evaluated at the end of one year. Association of age, American Society of Anaesthesiologists (ASA) grade, AO Foundation classification, osteoporosis to the functional outcome of modified Harris hip score (MHHS) was evaluated.ResultsType A2 fractures demonstrated a statistically higher-good reduction than Type A3 (Student t-test, P < 0.05). The difference in mean surgical duration in Type A3 (45.47 minutes) and Type A2 (40.30 minutes) was statistically significant (Student t-test, P < 0.05). Mean blood loss was 110.66 ml (SD = 48.40 ml). MHHS at 6, 12, 20 weeks, and one year were 40.37, 63.93, 79.03, and 82.34, respectively. At the end of the year, 46 (82.1%) patients achieved good scores, eight (14.3%) achieved fair scores, and two (3.5%) achieved poor scores. There was one case of nonunion and medial migration of the helical blade. The mortality rate was 6.55% at the end of one year.ConclusionA good reduction was associated with a better functional outcome. PFNA 2 is an efficient implant in managing unstable intertrochanteric fractures in elderly Indian patients with good outcomes, low morbidity rates, and mortality. Implant mismatch was not a problem in the Indian population. However, large multi-centric studies with a larger sample size are required. Moreover, achieving a good reduction cannot be over-emphasized in unstable intertrochanteric fractures, especially in the elderly, to achieve a good functional outcome.

Prospective study of functional outcome of unstable intertrochanteric fractures with hemiarthoplasty using bipolar prosthesis

Introduction: From many years the treatment for intertrochanteric fracture is internal fixation. Now hemiarthoplasty is being considered as a primary modality of treatment in unstable intertrochanteric fractures as it allows immediate full weight bearing and stability. Aim of present study is to analyse and evaluate the role of hemiarthoplasty in unstable intertrochanteric fracture. Materials and Methods: 20 patients with unstable, comminuted intertrochanteric fractures aged above 65yrs are considered in the study from January 2016 to December 2019. Exclusion Criteria: 1. Age less than 60yrs; 2. Stable intertrochanteric fractures; 3. Pathological fractures. Southern moores posterolateral approach was used. Cemented bipolar prosthesis was used in all cases. All cases were followed up for 1year. Patients were assessed using modified Harris hip score. Results: Average age in our study was 70 years according to boyd and griffin type 2 fractures were 16, type 3 were 4 patients. 2cms shortening seen in 5 patients, whereas1patient had limb shortening of 3 cms. Gluteus medius weakness was seen in 3patients. All cases were assessed using modified harris hip score, in 15 cases excellent to fair results were seen (75%), where as 2 cases (10%) had poor results. 3 patients died during the course of follow up and are excluded from study. In our study we had no Complications like stem loosening, periprosthetic fractures, infection and prosthetic dislocations. Conclusion: Primary cemented hemiarthroplasty can be used as an alternate to internal fixation for unstable trochanteric fractures. Keywords: Unstable fractures, Primary hemiarthroplasty, Harris hip score.

A comparative study on functional outcome of unstable intertrochanteric fractures in elderly treated with bipolar hemiarthroplasty and dynamic hip screw fixation: a short term perspective analysis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Trochanteric hip fractures in elderly patients have benefited from advances in internal fixation. Early failure of internal fixation occurs however in a number of cases. The failure after internal fixation had been due to initial fracture pattern, communication, sub-optimal fracture fixation and poor bone quality. The aim of this prospective comparative study is to analyze the short term follow up results of unstable Intertrochanteric fractures in elderly treated with bipolar hemiarthroplasty and dynamic hip screw (DHS) fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a study conducted in the Department of Orthopaedics, Government Tiruvarur Medical College, Tiruvarur. 42 elderly osteoporotic patients with unstable intertrochanteric fractures who were divided into two groups with group A-bipolar prosthesis (21 cases) and group B-DHS (21 cases).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 42 elderly osteoporotic patients with unstable intertrochanteric fractures who were divided into two groups with group A-bipolar prosthesis (21 cases) and group B-DHS (21 cases). Patients were evaluated clinically using the Harris hip score during their follow up period. In both groups, the most common Singh’s index was grade III, 61.90%in both group A and group B.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From our results, we are of the opinion that bipolar hemiarthroplasty may be an efficient option in elderly osteoporotic intertrochanteric fractures. It reduces the potential complications of prolonged immobilization such as pressure sores, pulmonary complications by early mobilization.&lt;/p&gt;

Primary cemented hemiarthroplasty for unstable intertrochanteric fractures in elderly severe osteoporotic patients

ObjectiveTo evaluate the outcome of unstable intertrochanteric fractures with primary cemented hemiarthroplasty (HA) in elderly severe osteoporotic patients. Material and MethodsIn January 2009 to July 2017, 277 patients were selected according to inclusion criteria and results were analyzed prospectively. According to AO/OTA Classification, only type 31-A2.2(148 cases) and 31-A2.3(129cases) were included. 53 cases were males and 224 cases were females. The mean age was 75.4 years. The mean follow-up period was 50 months. The Harris Hip Score (HHS) and perioperative index (including the time duration of the surgery, intraoperative blood loss, postoperatively weight bearing time, implant complications) were analyzed clinically. ResultsFollow-up evaluations were performed at 6 weeks, 3, 6, 9 and 12 months, and every year thereafter (mean 50 months). The average duration of surgery was 43.2 min (range 21–65 min), with a mean blood loss of 225.8 ml (range 70–425 ml). All patients were out of the bed and mobile with help of walker with average of 3.3 days (range 1–5 days). The average duration of hospital stay was 12.3 days. Average HHS improved from 83.7 (range 63–90) at 6 months follow up to 90.3 (range 74–92) at final follow up. ConclusionFor the severe osteoporotic elderly with unstable fractures, bipolar hemiarthroplasty is an effective method to treat the unstable intertrochanteric fractures in the severe osteoporotic elderly. It can decrease complications, reduce mortality, improve the patient's life quality, and reduce family burden. In Summation, when deciding on treatment methods for intertrochanteric fractures several factors must be considered, which are (included but not limited to) the type of fracture, the patient's age, health status, severity of osteoporosis. As long as there was no absolute contraindication for surgery, it is appropriate to have surgery and to restore function as early as possible.

Prospective study of functional outcome of unstable intertrochanteric fractures with hemiarthroplasty using bipolar prosthesis

Prospective study of functional outcome of unstable intertrochanteric fractures with hemiarthroplasty using bipolar prosthesis

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.

Effect of proximal femur nail anti-rotation on unstable intertrochanteric fractures: A prospective observational study

Objective: To assess the effect of proximal femur nail anti-rotation on the functional and radiological outcome of unstable intertrochanteric fractures. Methods: This prospective observational study was conducted in the orthopedic department of a tertiary care hospital. Altogether 86 patients with unstable intertrochanteric fractures treated with proximal femur nail anti-rotation between January 2010 and January 2015 were included. Patients were followed in the outpatient clinic at regular intervals after discharge to assess the radiological union of fractures and complications. The functional outcomes were evaluated after 2 years by Harris hip score. Results: All patients achieved a radiological union of fractures after a mean duration of 24.6 weeks. The follow up showed 23 complications (systemic and local). Eight patients developed urinary tract infections, and three patients developed chest infections, two patients had screw cut-out, one patient had knee stiffness, one patient developed superficial surgical site infection, and four patients developed varus collapse and shortening subsequently. The two year follow up showed that 69 (80.2%) patients had an excellent and good functional outcome according to Harris hip score. Conclusions: With lower complication rates, proximal femur nail is a valid and reasonable option especially in treating unstable intertrochanteric fractures.