A study on management of intertrochanteric fractures by various modalities

Introduction: Several fixation devices have been developed to overcome the difficulties encountered in the treatment of intertrochanteric femoral fractures. However the management of such fractures still remains a point of discussion. Aim of the Study: This study is undertaken to assess the various modalities of surgical management of intertrochanteric fractures and their clinical, functional and radiological outcomes in our institution. Materials and Methods: This is a prospective study from July 2015 to March 2017. The present study consists of 50 adult patients with intertrochanteric fractures of femur who are treated with DHS and PFN, Ender’s nails and Cemented bipolar prosthesis at Department of Orthopaedics, Prathima Institute of Medical Sciences, Nagunur, Karimnagar, Telangana State, India. All the patients with intertrochanteric fractures were selected among the admissions, operated and results were assessed clinically and radiographically. Clinical evaluation was made using the Modified Harris hip score. Perioperative complications were recorded. The mean follow-up period was 6months. Results: Fracture union was achieved in all cases. Bony consolidation was seen after a mean of 20weeks (range 18 to 22 weeks) and the time until full weight bearing ranged from 10 to 18 weeks. The mean Harris hip score was 85.02 (DHS – 25, PFN-09, CEMENTED BIPOLAR 09, ENDERS NAIL-07). None of the patients had a poor Harris hip score. Superficial wound infection occurred in 3 patients and varus collapse in 4 patients. Conclusion: Due to the quicker union time, earlier postoperative mobilization, shorter operation time and better functional outcome, PFN seems to have distinct advantages over the other implants and is currently the implant of choice in the surgical management of unstable intertrochanteric fractures. However, the DHS, PFN, CEMENTED BIPOLAR & ENDERS NAIL have their own set of advantages and indications and play a role in the management of certain specific fracture.