2018, Vol. 2 Issue 4, Part A
Abstract: Background and Objectives:
Subtrochanteric fractures of the femur remain one of the most challenging fractures facing orthopaedic surgeons. Most 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 poses difficulties in obtaining and maintaining a reduction, making operative management the preferred treatment. Hence this study intended to determine the effectiveness of intramedullary fixation of subtrochanteric fractures with long proximal femoral nail and the complications involved in the management of subtrochanteric fractures.
Methodology: This is a prospective study of 25 cases of Subtrochanteric fracture admitted to Rajah Muthiah Medical College and Hospitals between May 2016 and Aug 2018 treated with long proximal femoral nail. Cases were taken according to inclusion and exclusion criteria, ie. 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 25 cases, there were 16 male and 9 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. Seinsheimer Type IIIA 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 25 cases. Good-to-excellent results were seen in 80% of cases in our study.
Conclusion: From our study, we conclude that long PFN is a reliable implant for subtrochanteric fractures leading to hig 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 patienceare needed in order to make this method truly minimally invasive.