SURGICAL OUTCOMES OF SUBTROCHANTERIC FRACTURES OF FEMUR TREATED WITH PROXIMAL FEMORAL NAIL (PFN)

Abstract

BACKGROUND AND OBJECTIVES Subtrochanteric fractures of the femur remain one of the most challenging fractures facing orthopaedic surgeons. Most of the fractures in the elderly results from trivial fall from standing or walking, while in the younger age group it is mainly due to road traffic accidents. Closed management of these subtrochanteric fractures thus poses difficulties in obtaining and maintaining a reduction, making operative management the preferred treatment. Hence, this study is intended to determine the effectiveness of intramedullary fixation of subtrochanteric fractures with the proximal femoral nail and the complications involved in the management of subtrochanteric fractures. METHODOLOGY This is a prospective study of 90 cases of Subtrochanteric fracture admitted to Tagore Medical College and Hospitals between October 2013 and Jan 2016 treated with the proximal femoral nail. Cases were taken according to inclusion and exclusion criteria, i.e. fresh Subtrochanteric fracture in adults. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. RESULTS In our study of 90 cases, there were 75 male and 15 female patients with age ranging from 17 years to 75 years with most patients in between 21-40 years; 67% of the cases admitted were road traffic accidents, 23% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 12 days and mean time of full weight bearing was 14 weeks in our patients. Out of 90 cases, 9 cases were lost in follow-up and 3 cases died. Good-to-excellent results were seen in 80% of cases in our study. CONCLUSION From our study, we conclude that PFN is a reliable implant for subtrochanteric fractures leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience are needed in order to make this method truly minimally invasive.