STUDY OF PROXIMAL FEMORAL NAILING IN THE MANAGEMENT OF SUBTROCHANTERIC FRACTURES OF FEMUR

Background: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 xed with PFN. Materials and Methods: Study was conducted in the Department of Orthopaedics, DMCH, Laheriasarai, Bihar from June 2019 to November 2019. 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 signicant. Results: At the end of ve months, all except three patients could mobilise independently; statistically there was signicant 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.

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Functional outcome of Subtrochanteric Fractures of femur fixed with Dynamic Condylar Screw (DCS).

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.2514 ◽

2020 ◽

Vol 27 (02) ◽

pp. 225-229

Author(s):

Masroor Ahmed ◽

Ghulam Hussain ◽

Mukesh Kumar ◽

Nida ◽

Rukhsana Hamid

Keyword(s):

Functional Outcome ◽

Road Traffic ◽

Subtrochanteric Fracture ◽

Female Ratio ◽

Subtrochanteric Fractures ◽

Femur Fractures ◽

Dynamic Condylar Screw ◽

Quasi Experimental ◽

Subtrochanteric Femur Fractures ◽

Male To Female

Objectives: To determine functional outcome of Subtrochanteric femur fractures fixed with dynamic condylar screw. Study Design: Single group quasi experimental study. Setting: Orthopedic Surgery, creek general hospital, united medical and dental college and KVSS SITE hospital Karachi. Period: 15th February 2015 to 30th November 2016. Material & Methods: All the patients with Type 32A (A1, A2 and A3) subtrochanteric fractures of femur presenting within two weeks of injury were included in the study. Functional outcome was assessed by modified Schatzker and Lambert Criteria. Results: 79 patients with closed subtrochanteric fractures were included in study. The mean age of the patients was 41.2±12.98 years, mean duration of fracture was 4.58±1.25 days. Male to female ratio was 2.04 to 1, 42(53.16%) were injured in road traffic accident and 37(46.84%) were due to fall, right side were effected in 40.51% cases and left side effected in 59.49% cases. Acceptable functional outcome achieved in 82.28% (65/79) of cases. Conclusion: We conclude that open reduction and internal fixation are the best procedure to treat difficult fractures like subtrochanteric fractures and to avoid complications like implant failure, nonunion, and mal-union. In our study we attained satisfactory results by the use of dynamic condylar screw in patients with subtrochanteric fracture of femur.

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Functional outcome of Subtrochanteric Fractures of femur fixed with Dynamic Condylar Screw (DCS).

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.02.2514 ◽

2020 ◽

Vol 27 (02) ◽

pp. 225-229

Author(s):

Masroor Ahmed ◽

Ghulam Hussain ◽

Mukesh Kumar ◽

Nida - ◽

Rukhsana Hamid

Keyword(s):

Functional Outcome ◽

Road Traffic ◽

Subtrochanteric Fracture ◽

Female Ratio ◽

Subtrochanteric Fractures ◽

Femur Fractures ◽

Dynamic Condylar Screw ◽

Quasi Experimental ◽

Subtrochanteric Femur Fractures ◽

Male To Female

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

10.36106/gjra/8411863 ◽

2021 ◽

pp. 65-69

Author(s):

Dinesh Kumar Bairwa ◽

Jitendra Aloria ◽

Vishnu Prasad ◽

Ashok Kumar Tiwari

Keyword(s):

Locking Plate ◽

Weight Bearing ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Subtrochanteric Fractures ◽

Femoral Nailing ◽

Femoral Nail ◽

Prospective Comparison ◽

Anatomic Reduction ◽

Proximal Femoral Nailing

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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Evaluation of outcome following clamp assisted mini open reduction and internal fixation with intramedullary nailing of subtrochanteric femoral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194818 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1126

Author(s):

Chirag G. Prajapati ◽

Rasik B. Dabhi ◽

Nikunj D. Maru

Keyword(s):

Intramedullary Nailing ◽

Femoral Fractures ◽

The Elderly ◽

High Energy ◽

High Rate ◽

Excellent Outcome ◽

Subtrochanteric Fractures ◽

Femur Fractures ◽

Subtrochanteric Femur Fractures

Background: Subtrochanteric fractures of the proximal femur have been defined as the fractures extending from lesser trochanter distally for 5 cm. These fractures usually occur in two age distributions. In the elderly osteopenic population resulting from trivial trauma as fall from standing height or in the younger ones as a result of high energy trauma. Incidence has been on the rise and they comprise about 7 to 10% hip fractures and could lead quickly to large amount of blood loss and other complications.Methods: This is a multicentric prospective prognostic study level 1 consisting of 25 patients admitted in government civil hospital, Ahmedabad during April 2013 to May 2015 having high subtrochanteric femur fractures treated by clamp assisted reduction and intramedullary nailing. Out of these, 20 patients (80%) came for final follow up with average follow up of 11.5 months and evaluated for union, complication and functional outcome.Results: In our study final outcome is assessed based on hip outcome score (modified) based on which 85% had excellent outcome, 10% had good outcome and 5% had fair outcome with none of the patient having poor outcome.Conclusions: We found that clamp-assisted reduction and intramedullary nail fixation provides excellent reduction quality, high rate of fracture union, with no apparent increase in complications in subtrochanteric fractures of the femur.

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TO EVALUATE THE EFFICACY OF KICK STAND SCREW IN FIXATION OF SUBTROCHANTERIC FEMORAL FRACTURES USING CONTRALATERAL REVERSED DISTAL FEMORAL LOCKING PLATEPROSPECTIVE SINGLE CENTRIC STUDY

10.36106/ijar/9401597 ◽

2020 ◽

pp. 1-4

Author(s):

Prashant Pandey ◽

K K Pandey ◽

Ajay Dhanopeeya ◽

Surya Prakash Garg

Keyword(s):

Proximal Femur ◽

Locking Plate ◽

Harris Hip Score ◽

Plate Bending ◽

Neck Shaft Angle ◽

Subtrochanteric Fractures ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Shaft Angle

PURPOSE- All type of plates when used for proximal femur fractures always has chances of mechanical failure due to lack of strength of the construct, but addition of ‘kick stand screw’ has some effects on stability of the construct. Aim of our study is to evaluate the efficacy of kick stand screw in fixation of subtrochanteric fractures using contralateral reversed distal femoral locking plate. METHOD- 30 patients of subtrochanteric fractures fixed using contralateral reversed distal femoral locking plate. N(1st)=15 fixed without kick stand screw and other N(2nd)=15 fixed using kick stand screw. Calcar screw( Kick Stand Screw) is placed to support calcar region (inferior to the center in AP view and central in Lateral view). In other group screws are placed as oriented in screw holes. Outcome was assessed using Harris Hip Score and VAS score and change in the neck shaft angle is also followed. RESULT- Union rate was 80% in 1st group as compare to 94% in second group. Mean Harris hip score at the one year follow up was 71.2 in 1st group as compare to 89.2 in 2nd group. Mean Visual analogue scale was 3.2 in first group as compare to 1.6 in second group at final follow up. Mean neck shaft angle at final follow-up was 120 degree in first group as compared to135 degree in second group. Complication- 1st Group of patients had three failures 2 in the form of screw break down and one in the form of plate bending, all three lend up in to varus deformity but the 2nd group had only one failure in the form of plate bending. CONCLUSION-In our study cases in which kick stand screw was used they showed better mechanical strength and gave better clinical results. So in proximal femur fractures including subtrochanteric fracture fixation ‘kick stand screw’ must be used.

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Finite Element Analysis of Proximal Femoral Nail Anti-Rotation Blade Combined with Cerclage Wire Fixation for Osteoporotic Subtrochanteric Fracture

Advances in Bioengineering and Biomedical Science Research ◽

10.33140/abbsr.04.03.03 ◽

2021 ◽

Vol 4 (3) ◽

Keyword(s):

Internal Fixation ◽

Weight Bearing ◽

Bed Rest ◽

Biological Properties ◽

Subtrochanteric Fracture ◽

Intramedullary Nails ◽

Element Analysis ◽

Cerclage Wire ◽

Subtrochanteric Fractures ◽

Femur Fractures

Osteoporosis is a type of systemic bone disease wherein the patient is highly vulnerable to bone fracture because of the decrease in bone density and quality, destruction of the bone microstructure, and an increase in the bone fragility. Most of the osteoporotic subtrochanteric fractures are unstable in nature, requiring the conservative treatment of a long-duration bed rest and traction; this condition is prone to complications resultant from extended bed rest, often leading to death. Presently, the preferred treatment is internal fixation, such as sliding hip screws, blade plates, locking compression plates, and femoral intramedullary nails [1-8]. Owing to its valuable biological properties, intramedullary nail can be used for the optimal fixation of subtrochanteric fractures [9-11]. Unless any contraindication exist, immediate tolerable weight-bearing activities may be allowed to patients with subtrochanteric femur fractures who have been treated with statically locked intramedullary nails [12]. Considering that the proximal femoral fracture occurs under the traction of the surrounding muscles, it is extremely challenging to perform precision reduction and fixation in the surgery. Inappropriate reduction and selection of internal fixation can easily lead to failure of internal fixation, resulting in complications such as lower limb shortening deformity, hip varus deformity, and nonunion of fracture. Presently, good outcomes have been reported with the use of PFNA combined with cerclage wire for the treatment of subtrochanteric fracture of the femur [13-15]. There are few studies to help decide whether PFNA should be combined with cerclage wire or used alone according the Seinsheimer classification of subtrochanteric fractures.

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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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Subtrochanteric Fracture following Removal of a Porous Tantalum Implant

Case Reports in Orthopedics ◽

10.1155/2013/946745 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Derek F. Amanatullah ◽

Randall Farac ◽

Thomas J. McDonald ◽

H. David Moehring ◽

Paul E. Di Cesare

Keyword(s):

Core Decompression ◽

Subtrochanteric Fracture ◽

Porous Tantalum ◽

Significant Challenge ◽

Femoral Head Collapse ◽

Femur Fractures ◽

Femoral Cortex ◽

Distal Border ◽

Subtrochanteric Femur Fractures ◽

Femoral Implants

Osteonecrosis of the hip accounts for about 10% of all total hip arthroplasty cases and presents a significant challenge for those patients with and without femoral head collapse. Subtrochanteric femur fractures have been reported with numerous types of proximal femoral implants. Care must be taken to avoid penetrating the lateral cortex of the proximal femur inferior to the distal border of the lesser trochanter. Core decompression requires a 3 mm to 20 mm defect in the lateral femoral cortex. Subtrochanteric femur fractures are a well-known complication of core decompression as well. We present a case of a subtrochanteric fracture following the removal of a porous tantalum implant.

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Minimally Invasive Nail Insertion Technique for Subtrochanteric Femur Fractures

Techniques in Orthopaedics ◽

10.1097/bto.0b013e31817bf2ce ◽

2008 ◽

Vol 23 (2) ◽

pp. 118-125 ◽

Cited By ~ 1

Author(s):

Hassan R. Mir ◽

T A. Russell

Keyword(s):

Minimally Invasive ◽

Insertion Technique ◽

Femur Fractures ◽

Nail Insertion ◽

Subtrochanteric Femur Fractures

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Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172079 ◽

2017 ◽

Vol 3 (4) ◽

pp. 728

Author(s):

Shankar Linga S. ◽

Janardhana Aithala P. ◽

Amarnath Savur

Keyword(s):

Functional Outcome ◽

Harris Hip Score ◽

Walking Ability ◽

Trochanteric Fractures ◽

Femoral Nailing ◽

Femur Fractures ◽

Time Period ◽

Hip Screw ◽

A Prospective Study ◽

Proximal Femoral Nailing

Background: In view of the high incidence of implant failure and varus collapse seen in unstable inter trochanteric femur fractures treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) has gained popularity.1,2 However there is limited literature regarding functional outcome following PFN especially in Indian patients. In this study, our aim was to assess functional outcome following PFN of unstable inter trochanteric femur fractures which includes the ability to sit cross leg and squat.Methods: This prospective observational study was done at the associated hospitals of KMC Mangalore, spanning a time period of around 2 years, from October 2014 to July 2016. All patients who presented with isolated closed unstable inter-trochanteric fractures were included in the study. Patients were treated with proximal femoral nailing and followed up for a minimum period of 6 months. Outcome measures included Harris hip score, walking status and ability to sit cross leg and squat.Results: 40 consecutive patients (Mean age 61 years, range 25-95) were included in the study, all fractures united within 6 months. As per Harris hip score, 25 patients (62.5%) had excellent or good results, 8 patients (20%) had fair and 7 patients (17.5%) had poor results. 74% (20 out of 27) regained their gainful working status. 80% (24 out of 30) were able to squat easily or with some difficulty and 74% (20 out of 27) patients were able to sit crossed leg with or without difficulty. 82% (23 out of 28) regained their unassisted walking status.Conclusions: For unstable inter trochanteric femur fracture PFN gives good results in terms of union, walking ability and majority of the patients regained their pre injury activity status including squatting and cross leg sitting.

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