A prospective study of management of subtrochanteric femur fracture using proximal femoral nail

Zillur Rahman Siddique et al; Sch J App Med Sci, Nov, 2020; 8(11): 2436-2438, 2020

Objective: In this study our main goal is to evaluate the functional outcome of the treatment of subtrochanteric fracture of femur fixed by proximal femoral nail (PFN). Method: This clinical trial study was conducted at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka January 2017 to June 2018. Results: During the study, 40% of the cases femoral nail was fixed within 10 days of occurrence of fracture, while in rest 60% of cases, fixation was done after 10 days of fracture. The mean interval between injury and nail fixation was 10.9 days and the minimum and maximum intervals were 8 and 13 days respectively. Evaluation of outcome 12 months after nail fixation showed that 80% of the patients had good outcome (Haris Hip Score between 80 - 89) and the rest 20% had fair outcome (Haris Hip Score between 70 - 79). Conclusion: From our study we can conclude that, the proximal femoral nail is a safe and reliable implant for the treatment of subtrochanteric fractures of femur. Majority of the patients return to preinjury activities with mild limitations in hip movement

Aims: 1) Evaluation of Effectiveness and strength of Proximal Femoral nail in management of Trochantric and Sub-Trochantric Fractures. 2) Early mobilization and functional recovery of patient Objectives: 1) Stable Internal Fixation designed to fulfill biomechanical demands. 2) Toassist & enhance fracture healing. Method: It is a prospective study carried out from 2008 to 2014 in the Dept. Of Orthopaedics, RMC, Loni. Total 39 cases were treated. Boyd and Griffins classification is used. Majority of cases were from of 5 th-8 th decade of life. Stability of fractures is judged by presence of posterior-medial femoral cortex integrity. In all cases standard 25 mm PFN of 135 0 /130 0 were used. Results: After average follow-up of one year good to Excellent Hip range of motion was seen in 36 cases. All cases showed fracture union. No Z effect seen in any case. Except 2 cases which showed Reverse z effect and in 1 case nail breakage was seen without affecting functional abilities. Average fracture union time was 16 weeks. Conclusion: Proximal Femoral Nail is biomechanically sound fixation, minimally invasive which permits early mobilization, prevents excessive varus collapse at fracture site, produces less stress riser effect below tip of nail. But it also appears from this series that Indications of fixation are limited, excessive Lateral cortex comminution may limit its use. Still Proximal femoral nail is to be time tested to call it as best treatment modality for inter torchanteric & subtrochanteric fractures

IP innovative publication pvt. ltd, 2019

Introduction: The difficult nature of treating subtrochanteric fracture stems in part from the fact that this injury pattern is anatomically distinct from other proximal femoral peritrochanteric fractures and also from the femoral shaft fractures. The present study was made attempt to evaluate the functional outcome of subtrochanteric femur fractures treated with proximal femoral nail. Materials and Methods: The present study conducted on subtrochanteric femur fracture cases admitted in GSL medical college and general hospital, Rajahmundry during December 2013 to July 2015. Ethical Committee Clearance was obtained before beginning of the study. All patients were maintained on traction before surgery. All surgeries were done under spinal or epidural anaesthesia, low molecular weight heparin prophylaxis is given subcutaneously for the high risk patients during the hospitalization. Result: Majority of the cases were due to high energy trauma of Road traffic Accidents involving relatively younger patients. The operating time for 72% cases was between 1 to 2 hours. Operating time decreased with increasing familiarity of the implant system. The average length of Hospital stay was 17.6 days. At the end of five months, all except three patients could mobilise independently without any aid. According to harris hip score, 3 (12%) patients had excellent outcome, 18 (72%) patients had good outcome and 4 (16%) patients had fair outcome. Conclusion: In conclusion, Proximal femoral nail is a good implant for subtrochanteric fracture of the femur. The advantages are minimal exposure (closed technique), better stability and early mobilisation. Fractures united in all cases and postoperative functional outcome was satisfactory.

IP innovative publication pvt. ltd, 2019

Introduction: The proximal femoral nail (PFN) used as an intramedullary device for the treatment of fractures. Objectives: Study was taken to analyse the union of the subtrochanteric fracture, internally fixed with PFN. Materials and Methods: Study was conducted in the department of orthopaedics, GSL Medical College. Individuals with acute subtrochanteric femur fractures >18 years were included in the study. The patient was positioned supine on the fracture table under spinal or epidural or general anesthesia as the condition of the patient permitted. Pre-operatively one dose of antibiotic was also administered. The fracture was reduced by longitudinal traction on fracture table and the limb was placed in neutral or slight adduction to facilitate nail insertion through the greater trochanter ; P <0.05 was considered statistically significant. Results: At the end of five months, all except three patients could mobilise independently; statistically there was significant difference (P<0.05). Based on Harris Hip score obtained 3 patients outcome was excellent, 18 patients were good and 4 patients had fair outcome. Conclusion: Minimal exposure, better stability and early mobilization are the advantages with PFN. Fractures united in all cases and postoperative functional outcome was satisfactory. PFN could be a preferred implant of choice in treating subtrochanteric fractures especially in elderly.

Journal of Evolution of Medical and Dental Sciences, 2016

International Journal of Research in Orthopaedics, 2018

Pakistan Journal of Medical and Health Sciences, 2022

International Journal of Research in Orthopaedics, 2017

Background: Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.Methods: It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment.Results: In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 ca...

European Journal of …

2020

Introduction: Fractures of the proximal femur including the intertrochanteric and subtrochanteric region which are commonly encountered in Orthopaedics especially in elderly population having porotic and weak bones. In elderly these occur even with minimal or trivial trauma ,whereas in the younger population these result from high velocity trauma. These injuries are in association with a high incidence of mortality and morbidity. These injuries were treated conservatively prior to the early 1970’s and are now treated totally surgically now. The goal of any treatment in fracture is stable fixation, ultimately leading to early mobilization and decreased incidence of morbidity and mortality. Many surgical interventions like Gamma Nail, Jewet Nail, Condylar plates had been tried but the outcomes were not very satisfactory, so we conducted a study to determine the clinical and radiological outcome in treating such fractures with PFN. Aim of the Study: Clinical And Radiological Outcome An...