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To study the management of proximal femoral fractures by proximal femoral nail

Author: 
Dr. Kiran Gaonkar, Dr. Pravin Patil, Dr. Nishant Gaonkar, Dr. Ketan Gupta, Dr. Rupesh Gor, Dr. Aminuddin Qureshi and Dr. Jimit Shah
Subject Area: 
Health Sciences
Abstract: 

Peritrochanteric fractures mainly comprise of fractures of trochanter and subtrochanteric region. Despite marked improvements in implant design, surgical technique and patient care, peritrochanteric fractures continues to consume a substantial proportion of our health care resources. Trochanteric fractures are common in the elderly people. The more latest implant for management of trochanteric fractures is proximal femoral nail, which is also a collapsible device with added rotational stability. This implant is a centromedullary device and biomechanically more sound. It also has other advantages like small incision, minimal blood loss. Aims and Objectives is to study the management of proximal Femoral fractures by proximal Femoral nail and to study perioperative difficulties and postoperatitve outcome in these fractures. Material and Methods: The present study consists of 25 adult patients of peritrochanteric factures of femur, who are treated with Proximal Femoral nail. Patient were followed up six weeks, three months, six months and 12 months. Movements, union and limb length were assessed clinically and postoperative complications like delayed union, nonunion, malunion and implant failure were studied radiologically during these visits. Modified Harris Hip Score was used for evaluation of hip function. Observation and Results: In our series of 25 operated cases, 3 cases were expired before first follow up due to other medical problems and old age. 3 cases were lost follow up after first follow up. So taking into consideration of 19 cases of which we had 12 months regular follow up, by using Modified Harris Hip Score we got 47.37% excellent, 47.37%good and 5.26%poor results. Complications like malunion and shortening of more than 1 cms was seen in 1 case each and implant failure was seen in 3 cases. Conclusion: Though the learning curve of this procedure is steep, with proper patient selection, good instrumentation, image intensifier and surgical technique, PFN remains the implant of choice in the management of Peritrochanteric fractures.

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