A PROSPECTIVE COMPARISON OF THE PROXIMAL FEMORAL NAIL VERSUS THE PROXIMAL FEMORAL LOCKING PLATE IN SUBTROCHANTERIC FEMORAL FRACTURES.

BACKGROUND: Subtrochanteric fractures account for 10% to 30% of all hip fractures. The fractures were repaired with a variety of implants. Direct anatomic reduction or indirect reduction and bridge plating procedures are also possible with the proximal femoral locking plate (PFLP). Proximal femoral nails (PFN) have been demonstrated to be superior to other implants due to biomechanical advantages. The goal of this study was to compare the radiological and functional outcomes of subtrochanteric fractures treated with the proximal femoral nail (PFN) and the proximal femoral locking plate (PFLP), in order to determine which implant was the best t for the specic fracture pattern. METHODS: 50 patients with a Subtrochanteric femur fracture were operated on and treated with a proximal femoral nail and a proximal femoral locking plate (25 in each group). A 24-month follow-up was completed. The Harris Hip Score (HHS) and radiological results were used to determine the outcome. When compared to patients treated wit RESULTS: h a proximal femoral locking plate, individuals treated with proximal femoral nailing required considerably less time to achieve complete weight bearing. In patients treated with a proximal femoral locking plate, radiological union was considerably delayed compared to patients treated with proximal femoral nailing. The average HHS in the nailing group was slightly higher than in the plating group. PFN have the advantage by taking less operative time, high rate of union, mi CONCLUSION: nimal soft tissue damage, less infection rate and early postoperative rehabilitation. In our research, we discovered that both PFN and PFLP can be utilised successfully to treat Subtrochanteric fractures. In terms of anatomical alignment, limb length disparity, postoperative infection, and, most critically, the nal Harris Hip Score, there was no signicant difference between implants.

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Critical analysis of factors determining mechanical failures in proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190504 ◽

2019 ◽

Vol 5 (2) ◽

pp. 275 ◽

Cited By ~ 1

Author(s):

Karthik Ramachandran ◽

K. K. Arvind Manoj ◽

A. Vishnu Sankar

Keyword(s):

Failure Rate ◽

Mechanical Failure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Excellent Outcome ◽

Lag Screw ◽

Femoral Nailing ◽

Femoral Nail ◽

Proximal Femoral Nailing

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.

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Retrospective study for the results of proximal femoral nailing in subtrochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202560 ◽

2020 ◽

Vol 6 (4) ◽

pp. 699

Author(s):

Manthan H. Mandalia ◽

Hasmukh L. Kubavat ◽

Nirav Trivedi

Keyword(s):

Retrospective Study ◽

Age Groups ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Stable Fixation ◽

Early Mobility ◽

Subtrochanteric Fractures ◽

Femoral Nail ◽

Intramedullary Implant ◽

Returning To Work

Background: Subtrochanteric fractures are prevalent in young and old age groups and one of the most notorious to achieve a stable fixation which allows early union and mobilization. This was a retrospective study to analyse the outcomes of proximal femur nailing in subtrochanteric fractures and assess the functional outcome, radiological union and compare that with studies of other modalities.Methods: This was a retrospective study of 40 patients with sub trochanteric fractures classified by Sienshiemer classification and operated by proximal femoral nail implant. Clinical evaluation was done by Harris hip score.Results: The average union time in our study was 5.12 months lower than some of the union rates of series with other implants (AO blade plate 7.7%). The conducive environment provided by proximal femoral nail (PFN) allows early mobility, independence to the patient and lessens the complications due to the bed ridden state and decrease the time in returning to work.Conclusions: Our study suggests that PFN being and intramedullary implant gives stable fixation and early union as compared to extramedullary implants with less blood loss and less complications.

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Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i8.36401 ◽

2021 ◽

Vol 12 (8) ◽

pp. 125-129

Author(s):

Pratyenta Raj Onta ◽

Dilip C Agarwal ◽

Upendra Jung Thapa ◽

Pabin Thapa ◽

Krishna Wahegoankar ◽

...

Keyword(s):

Blood Loss ◽

Weight Bearing ◽

Invasive Procedure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Femoral Nail ◽

The Mean ◽

Proximal Femoral Nail Antirotation ◽

A Prospective Study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

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A prospective comparative study of Proximal Femoral Nailing Anti-rotation (PFNA) and Sliding Hip Screw (SHS) for Per-trochanteric Femur Fracture

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i2.1392 ◽

2020 ◽

Vol 24 (2) ◽

pp. 156-160

Author(s):

Amer Khan ◽

Muhammad Ali ◽

Ayesha Tahir ◽

Muhammad Saleem ◽

Usman Sarwar ◽

...

Keyword(s):

Hospital Stay ◽

Functional Outcome ◽

Femur Fracture ◽

Weight Bearing ◽

Harris Hip Score ◽

Complication Rates ◽

Sliding Hip Screw ◽

Femoral Nailing ◽

Hip Screw ◽

Proximal Femoral Nailing

Objectives: To determine the functional outcome, operative risks, rate of union, and complication in Per-trochanteric Fracture fixed with PFNA and SHS. Material and Methods: The present study has been conducted at Shalamar Medical and Dental College Lahore from January 2018 to December 2018.40 patients with per-trochanteric femur fracture treated with proximal femoral nailing anti-rotation (PFNA) and Sliding hip screw (SHS) were enrolled in our study.20 patients were treated by PFNA and 20 patients by SHS. Timing of surgery, mobilization status, hospital stay, infection, weight-bearing status, radiological union, complications both technical and implant-related, amount of blood loss(ml), C ARM Exposures, and Harris hip score at the end of 6 months were recorded. Results: Union was better in the PFNA group (95%) as compared to the SHS group (85%). Complication rate, hospital stay, surgery timing, and requirement of revision surgery were more in the SHS group. The functional outcome was better in the PFNA group as compared to the SHS group. Conclusion: From our study, we concluded that PFNA is a better alternative than SHS in terms of higher union rates, low complication rates, and better functional outcomes.

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Management of Subtrochanteric Fracture Femur- by ProximalFemoralNailing

Annals of International medical and Dental Research ◽

10.53339/aimdr.2022.8.1.18 ◽

2022 ◽

Vol 8 (1) ◽

pp. 132-140

Author(s):

Girish Sahni

Keyword(s):

Excellent Result ◽

Tertiary Care ◽

Subtrochanteric Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Subtrochanteric Fractures ◽

Femoral Nail ◽

One Year ◽

Modified Harris Hip Score ◽

A Prospective Study

Background: Numerous variations of intramedullary nailing have been evolved over the years for stable fixation and early mobilisation of subtrochanteric fracture, out of which one is proximal femoral nail. Aims and objectives –We conducted this study with an objective to evaluate the results of internal fixation of subtrochanteric fractures of the femur with proximal femoral nail – AO type Design.Methods:This was a prospective study carried out at our tertiary care institute on 30 patients who had suffered subtrochanteric fracture and were subsequently treated with a proximal femoral nail (PFN). Proximal femoral nail was inserted through the tip of greater trochanter. All patients were followed up for a period of one year; at an interval of 3 months and during each follow-up visit for the functional outcome by modified Harris Hip Score, was assessed in the form of walking, squatting, sitting and rising from chair.Results:Modified Harris hip score was used for the evaluation of results in our study which showed excellent result in 21 patients (70%), good results in 3 cases(10%), fair results in 3 patient (10%) and poor results in 3 cases(10%). The mean Harris hip score in our study was 90.6.Conclusion:PFN is an intramedullary load sharing implant. Reduction and management of subtrochanteric fractures is challenging in traumatology. Proximal femoral nailing spanning whole femur with proximal and distal locking appears to be a satisfactory implant in management of fractures of subtrochanteric femur.

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Surgical Selection of Unstable Intertrochanteric Fractures: Proximal Femoral Nail Antirotation Combined With or Without Cerclage Cable

10.21203/rs.3.rs-29927/v1 ◽

2020 ◽

Author(s):

Qing-Chao Huang ◽

Xing Wu

Keyword(s):

Internal Fixation ◽

Fracture Healing ◽

Weight Bearing ◽

Proximal Femoral Nail ◽

Fixation Method ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Proximal Femoral Nail Antirotation ◽

Selection Of

Abstract Background: Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation remains challenging for orthopedic surgeons. This study aims to compare the clinical efficacy of proximal femoral nail antirotation (PFNA) combined with a cerclage cable and without a cerclage cable so as to recommend a stable internal fixation method.Methods: From January 2014 to January 2018, we retrospectively analyzed all unstable intertrochanteric fracture cases who received treatment in the Orthopedics Department of our hospital. One hundred and twenty cases were screened, of which 51 were treated with a cerclage cable, and 69 without a cerclage cable. The follow-up period was one year. Patients were divided into either the PFNA and cerclage cable group (PFNA+cable) or the PFNA only (PFNA) group. Results: The Harris hip score (HHS), Barthel Index (BI), and Radiographic Union Scale for Hip (RUSH) were evaluated.The fracture healing and weight-bearing time of the PFNA+cable group were shorter than the PFNA group. Regarding the HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1, 3, 6, and 12 months after the operation. For the HHS rating, the PFNA+cable group had a higher-excellent rate than the PFNA group, with 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. The application of a cerclage cable was found to reduce the incidence of complications.It was found that PFNA combined with a cerclage cable improved the stability of fracture reductions, shortened the fracture healing time and postoperative weight-bearing time, significantly improved patients’ ability to self-care, and reduced the incidence of postoperative complications. Conclusions: Therefore, we think PFNA combined with a cerclage cable is a good choice for patients with unstable intertrochanteric fractures.

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Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203721 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1001

Author(s):

Mayur Chopra ◽

Sanjay Kumar Srivastava ◽

Sumit Kumar ◽

Deepak Kumar Mishra

Keyword(s):

Weight Bearing ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Radiological Outcome ◽

Neck Length ◽

Neck Shaft Angle ◽

Femoral Nail ◽

Shaft Angle ◽

Tip Apex Distance

Background: Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.Methods: 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.Results: The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593Conclusions: With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200739 ◽

2020 ◽

Vol 6 (2) ◽

pp. 292

Author(s):

Shwetabh Malik ◽

Parimal Malviya ◽

Alfven Vieira ◽

Deepak Jain

Keyword(s):

Proximal Femur ◽

Femur Fracture ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Medullary Canal ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Subtrochanteric Fractures ◽

Femur Fractures ◽

Femoral Nail

Background: Proximal femur fractures present considerable challenge in management. They are due to high velocity trauma, with or without soft tissue injury and usually with a metaphyseal and diaphyseal involvement. The surgeon has to face many challenges like identifying the entry, reduction the fracture, and difficulty due to a narrow medullary canal and comminution. The present study was conducted to assess the utility and effectiveness of Proximal Femoral Nail for subtrochanteric fractures of femur.Methods: In this study a total of 30 patients with Sub trochanteric femur fracture admitted to MGM medical college and hospital from June 2015 to July 2017 were selected for treatment with proximal femur nail.Results: 30 patients were included in this study with subtrochanteric fractures of femur treated with Proximal femoral nail. Maximum 21(70%) of patients were below 61 yrs of age. Mean age was 47.9 years. There was 21 male and 9 females in the study. There were 6 patients with local complications. Final result of our study, we had 26.7% excellent, 46.6% good, 20% fair and 6.7 % poor results according to Harris hip score.Conclusions: In our study, looking at the results we found that Proximal femoral Nail proves to be a good implant in management of subtrochanteric fractures of femur. However, it is a small study to conclude anything definitely.

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SURGICAL OUTCOMES OF SUBTROCHANTERIC FRACTURES OF FEMUR TREATED WITH PROXIMAL FEMORAL NAIL (PFN)

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2016/779 ◽

2016 ◽

Vol 5 (52) ◽

pp. 3373-3377

Author(s):

Jenson Isaac ◽

Vijay Krishna ◽

Ranjith Kumar ◽

Shanmugavel Shanmugavel

Keyword(s):

Surgical Outcomes ◽

Proximal Femoral Nail ◽

Subtrochanteric Fractures ◽

Femoral Nail

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A Prospective Randomized Control Trial Comparing Proximal Femoral Nail and Sliding Hip Screw in The Management of Trochanteric Fracture of The Femur

Health Renaissance ◽

10.3126/hren.v9i1.4354 ◽

1970 ◽

Vol 9 (1) ◽

pp. 7-11

Author(s):

NK Kam ◽

Ashis Jain ◽

P Nepal ◽

Mahi Pal Singh ◽

N Das

Keyword(s):

Controlled Trial ◽

Trochanteric Fracture ◽

Proximal Femoral Nail ◽

Joint Disease ◽

Harris Hip Score ◽

Sliding Hip Screw ◽

Femoral Nail ◽

Number Of Patients ◽

Hip Screw ◽

Screw Group

Introduction: There are various implants designed for fixation of trochanteric fracture which can be extramedullary (Sliding hip screw) and intramedullary (Proximal Femoral Nail). A randomized controlled trial comparing these techniques was conducted at BP Koirala Institute of Health Sciences. Objective: To compare efficacy of proximal femoral nail and sliding hip screw in the management of trochanteric fractures. Methods: Patients in both groups were matched for age (mean 67 years, 50 to 100) and gender. We excluded all pathological fractures, patients presenting at more than one week, multiple fractures or any bone and joint disease interfering with rehabilitation. Results: The amount of blood loss and length of incision were significantly higher in the sliding hip screw group (p < 0.05). The time of union, range of movement and Western Ontario and McMasterUniversity knee scores were comparable at two years. The mean Harris hip score was better in proximal femoral group. Conclusion: The number of patients showing shortening, external malrotation and varus angulation was more in sliding hip screw group. There was one case of wound infection and a single case of breakage of implant in sliding hip screw group. Keywords: fracture trochanter; proximal femoral nail; sliding hip screw DOI: 10.3126/hren.v9i1.4354Health Renaissance, 2011: Vol.9 No.1:7-11

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