BACKGROUND; The current methods of treatment of Inter Trochanteric fractures of femur are either DHS plating for a
stable Intertrochanteric fracture or a Proximal Femoral Nail for an unstable IT fracture. There are increased surgical
demands and complications associated with Unstable IT fractures. Fracture patterns like –Posteromedial large separate fragment, Basi cervical
pattern, Reverse obliquity pattern, Displaced and/or avulsed greater trochanter, Lateral wall fractures pose challenges before operating surgeon.
Failure to reduce the fracture before internal xation and failure to hold the reduction till denitive xation are the most frequent causes of poor
results irrespective of the implant used for xation. . Present surgeon's usual preference is towards long PFN. There is an added advantage of
increased stability due to splinting of the whole length of femur with the use of long PFN. However there are times where short PFN is preferred
over long one when there is a mismatch of curvature between the nail and the femur. However, there is no pre-established treatment choice
protocol in choosing long nail or short nail for trochanteric fractures, but many surgeons are reluctant to use short proximal femoral nails biased
by literature showing more fracture rates with short PFN usage and with a belief that long nails can avoid stress risers in the diaphysis and make
peri- prosthetic fracture rates acceptable. Some of the drawbacks of long PFN include increased operative duration, reaming of the medullary
canal distally, unavailability of distal locking jig, leading to prolongation of distal locking time and exposing the surgical team to more radiation.
Stacking the above facts the study tried to verify these in the practical scenario. The study was conducted at the department of orthopaedics
Andhra Medical College Visakhapatnam Andhra Pradesh. Salvage procedures like Dimon osteotomy and Sarmiento osteotomy were not
entertained in the present study.This effectively limits the study to cephalomedullary xation of un stable per trochanteric fractures with short
and long Proximal Femoral Nail.
METHODS:
Study design: Hospital Based Comparative study.
Study period: October 2017 to September 2019.
Sample size: 30 (N=30, Short PFN-15, Long PFN-15)
The study population was randomly divided into 2 groups with 15 patients in each group. Group S (odd): The patients who were operated with
Short Proximal Femoral Nail. Group L (even): The patients who were operated with Long Proximal Femoral Nail.
RESULTS Thirty cases of unstable inter-trochanteric fractures treated with reduction and internal xation with long or short proximal femoral
nail were studied.
In the present study minimum age was 29 years and maximum age was 75 years.
Majority of the patients were between 51 to 70 years of age. Mean age for long PFN was 52.83 +/- 10.33 SD years, (Range 29-70). Mean age for
short PFN was 58.16 +/- 13.94 SD years, (Range 35-75). In the present study males predominate females with a male to female ratio of 3:2.
CONCLUSION We conclude that both short and long nails appear acceptable for use in unstable inter-trochanteric fractures. A reduction in
operative duration and reduction in blood loss, which translates into a reduced blood transfusion requirement more importantly signicant
reduction in image intensier exposures seen with short PFN makes it a surgeon friendly implant. We prefer long PFN for xation of unstable
trochanteric fractures with osteoporosis so as to splint the whole femur.
Unstable Trochanteric Fractures: The Role of Lateral Wall Reconstruction Using a Trochanteric Stabilization Plate with Cephalomedullary Nail
