Is proximal femoral nailing of unstable intertrochanteric fractures in the lateral decubitus position without a traction table as safe and effective as on a traction table?

Background: Intertrochanteric fractures are one of the commonest fractures encountered in elderly population. Though there are various implants, proximal femoral nail has been the standard choice for management of unstable fractures. Inspite of its biomechanical advantages, various complications like screw cut out, Z effect, reverse Z effect does occur in proximal femoral nailing. The aim of the study is to analyse various factors determining the mechanical failures in patients operated with proximal femoral nail.Methods: This is a prospective study conducted in our institution from June 2014 to May 2018. The study included 72 patients with unstable intertrochanteric fractures treated with proximal femoral nail. All patients were followed for average period of 2 years. Functional outcome was assessed using Harris Hip score.Results: Among the patients 33% had excellent outcome. 42% had good and 14% had fair outcome. 11% of cases ended with poor outcome. Mechanical failure rate was less in patients with positive medial cortical support (PMCS) and in patients with tip apex distance difference between antirotation screw and lag screw (TADAR -TADLS) more than 15 mm. Whereas the difference in the position of lag screw centre had no significant influence in the mechanical failure rate in our study.Conclusions: From our study we like to conclude that the fracture reduction with positive medial cortical support and the TAD difference play a major role in determining the incidence of mechanical failure in proximal femoral nailing.

Download Full-text

Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-15-00691 ◽

2017 ◽

Vol 25 (3) ◽

pp. e37-e44 ◽

Cited By ~ 5

Author(s):

Mesut Mehmet Sonmez ◽

Savas Camur ◽

Erden Erturer ◽

Meric Ugurlar ◽

Adnan Kara ◽

...

Keyword(s):

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Proximal Femoral Nailing

Download Full-text

Comparative study between dynamic hip screw and plate with proximal femoral nailing in trochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171909 ◽

2017 ◽

Vol 3 (3) ◽

pp. 602

Author(s):

M. K. Nizamoddin Khateeb ◽

Satish Babu D. G.

Keyword(s):

Early Mobilization ◽

Dynamic Hip Screw ◽

Care Hospital ◽

Intertrochanteric Fractures ◽

Sliding Hip Screw ◽

Medical College ◽

Femoral Nailing ◽

Hip Screw ◽

One Year ◽

Proximal Femoral Nailing

Background: Incidence of intertrochanteric fractures has increased significantly during recent years and it will probably continue to rise in near future due to increased longevity of life. Closed methods of treatment for intertrochanteric fractures have increased mortality rates & have largely been abandoned. Rigid internal fixation and early mobilization has been the standard protocol of treatment nowadays. This study was intended to compare the results of Intertrochanteric fractures treated by dynamic hip screw (DHS) over proximal femoral nailing (PFN).Methods: This is a randomized prospective study of 102 cases of intertrochanteric fractures, admitted to Mysore Medical College & Hospital, Mysore and ESIC medical college and hospital Kalaburagi and Kamareddy Ortho & Trauma care Hospital Kalaburagi; treated with proximal femoral nailing and DHS. The patients were divided randomly into two groups, each of 51 patients, 51 were treated by Dynamic Hip Screw & 51 were treated with proximal femoral nail (PFN).All patients were followed up for one year.Results: In our series of 102 patients of Intertrochanteric fractures, 51 were treated with sliding hip screw with plate and 51 were treated by an intra-medullary hip screw. Most of the patients were between 51 to 80 years. Slip and trivial fall accounted for 70% cases. Right side was more common accounted for 58.34% of cases. Conclusions: From our study, we consider PFN as better alternative to DHS in more unstable fractures with technically difficulty and require more experience. Sliding hip screw remains the implant of choice for stable type fractures. We noticed less operative time, less blood loss, fewer intra-op complications in PFN group. The quality of the reduction achieved & proper positioning of the implant are important to achieve the best post-operative outcome.

Download Full-text

A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205559 ◽

2020 ◽

Vol 7 (1) ◽

pp. 51

Author(s):

Gineshmon Chandy ◽

Saju S.

Keyword(s):

Functional Outcome ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Hip Screw ◽

Group 2 ◽

Proximal Femoral Nailing ◽

Radiological Union ◽

Unstable Fractures

Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome. Methods: Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.Results: Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2. Conclusions: PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures.

Download Full-text

Antegrade femoral nailing in the lateral decubitus position: a case series, technical tips and review of literature

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-03200-z ◽

2022 ◽

Author(s):

P. Johnsen ◽

J. Satpathy ◽

N. K. Patel ◽

E. Hansen ◽

V. Mounasamy

Keyword(s):

Case Series ◽

Lateral Decubitus Position ◽

Review Of Literature ◽

Femoral Nailing ◽

Lateral Decubitus

Download Full-text

COMPARATIVE STUDY OF PROXIMAL FEMORAL NAILING AND DYNAMIC HIP SCREW FOR INTERTROCHANTERIC FRACTURES IN ADULTS

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2016/474 ◽

2016 ◽

Vol 5 (35) ◽

pp. 2018-2021

Author(s):

Satya Kumar Koduru ◽

Siddharth Potluri ◽

Hanumantha Rao C ◽

Srinivas Raghav T

Keyword(s):

Comparative Study ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Hip Screw ◽

Proximal Femoral Nailing

Download Full-text

Outcome following proximal femoral nailing with helical head screw for intertrochanteric and subtrochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193826 ◽

2019 ◽

Vol 5 (5) ◽

pp. 865

Author(s):

Sudharsana Reddy Palle ◽

Santhosh Srinivasan ◽

D. Gokul Raj

Keyword(s):

Early Mobilization ◽

High Energy ◽

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Initial Stability ◽

Patient Groups ◽

Proximal Femoral Nailing ◽

Early Surgical Intervention ◽

Results Of Surgery

Background: Intertrochanteric fractures are seen commonly in two patient groups, older osteopenic patients after a low-energy fall and younger patients involved in high-energy trauma. Early surgical intervention is advocated in the majority of these patients to reduce the complications associated with long-term immobilization.Methods: In this study proximal femoral nailing with helical head screw is used to achieve initial stability and early mobilization of the patients to avoid complications. In 60 patients undergoing proximal femoral nailing with helical head screw for intertrochanteric fractures the results of surgery were meticulously followed.Results: The patients were assed clinically and radiologically for time of union rate of infection stability and implant failure. All fracture in our study unites within 8 months following surgery.Conclusions: Our study concludes that proximal femoral nailing with helical head screw is the best method of treatment for intertrochanteric fracture as it leads to lesser complications.

Download Full-text