Trochanteric fractures treated by proximal femoral nail - Our experience

Author : Sreeranga Nagaraj, Varun R, K Shankara, Lakshmeesha T, SC Kiran, Poornachandra, Lokesh P

Background & Objectives: Intertrochanteric fractures pose a challenging problem for orthopaedic surgeons. Many implants have come in vogue. Use of Proximal femoral nail in treatment of trochanteric fractures gives an advantage of being intramedullary device along with the decrease in the number of complications. Materials & Methods: In our study 50 patients who presented to the orthopaedic unit of Hassan Institute of Medical Sciences between january 2010 to july 2013 with intertrochanteric fractures were included. All were followed upto 2 years & the final outcome was assessed for the type of fracture using evanís classification, position of the lag screws, time of union and functional assessment score using kyle 's criteria. Results: Forty five patients completed 2 years follow up. 2 patients died after 1year due to co-morbid conditions & 3 were lost to follow-up. Based on Evan's classification 80% fractures- unstable 20%- stable, 76% of the lag screws in AP view were in the inferior quadrant & 92% in central position in lateral view, with mean time of union of 12.8 weeks. Functional results according to kyle's criteria were Excellent 55.6%, Good 31.1%, Fair 8.9% and Poor 4.4%. There were 3 cases of superficial infection, 2 cases of proximal migration (Z effect) & 1 case of screw breakage. All were adequately treated. Conclusions: PFN is a technically demanding procedure. Closed anatomical reduction, small size of incision, less blood loss, rigid fixation & early weight bearing are its advantages in helping patient return to his functional capacity at earliest.

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