Original Articles
Subtrochanteric femur fracture treated with long proximal femoral nail and its functional outcome | |
Dr. Arun KN, Dr. Shrinivas Kalliguddi, Dr. Mohan Patil, Dr. SP Balamurugan Pugazhendi | |
Background and introduction: Subtrochanteric (ST) femur fractures are defined as fractures of the proximal femur that occur within 5 cm distal to the lesser trochanter. The incidence of fractures of the proximal femur is markedly increasing because of increasing life expectancy and motor vehicle accidents. Subtrochantric fractures of the femur pose a great problem because of the diversity of fracture patterns and difficulty in attaining anatomical reduction. Methods: Hospital based study of 30 patients with subtrochanteric femur fractures (Russell Taylor type 1) admitted in Navodaya medical college hospital. Patients were operated after pre-operative evaluation. Regular follow ups were done at 4 weeks interval to assess functional outcome using Harris Hip score and Merle D’Aubigne score. Results: Out of 30 cases, majority were from 41-50 years followed by 23.3% from 31-40 years, 20% from 51-60 years and 13.3% each from less than 30 years and above 60 years each. 60% of the patients were male, Right side was affected in 56.7% and Road traffic accidents 90% were the most common mode of injury. Majority of the patients belonged to Russell Taylor type 1B i.e. 60% and remaining were type 1A i.e. 40%. Prevalence of complications in our study was 26.7%. Clinical outcome using Harris hip score showed excellent results in 56.7%, good in 26.7% and fair in 16.7% and outcome according to D'aubigne score showed very good results in 56.7%, good in 26.7%, medium in 10% and fair in 6.7%. Conclusion: Subtrochanteric fractures of femur are difficult to manage considering the amount of forces acting on the fracture fragments. Deciding between intamedullary and extramedullary fixation depends upon the fracture type and involvement of the piriformis fossa. Long PFN is a reliable implant for subtrochanteric fractures, which yields high union rate with minimal soft tissue damage. In our study the outcome with long PFN treatment showed 56.7% excellent and 26.7% good results with minimum complications. Long PFN fixation has biological and biomechanical advantages, but the operation is technically demanding. Key words: Subtrochanteric fractures, Russell Taylor type 1, Closed reduction, Long PFN, Harris Hip score |
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