Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures (original) (raw)
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Outcome Assessment in Proximal Femoral Fractures treated with Proximal Femoral Nail”
2020
Introduction: Fractures of the proximal femur including the intertrochanteric and subtrochanteric region which are commonly encountered in Orthopaedics especially in elderly population having porotic and weak bones. In elderly these occur even with minimal or trivial trauma ,whereas in the younger population these result from high velocity trauma. These injuries are in association with a high incidence of mortality and morbidity. These injuries were treated conservatively prior to the early 1970’s and are now treated totally surgically now. The goal of any treatment in fracture is stable fixation, ultimately leading to early mobilization and decreased incidence of morbidity and mortality. Many surgical interventions like Gamma Nail, Jewet Nail, Condylar plates had been tried but the outcomes were not very satisfactory, so we conducted a study to determine the clinical and radiological outcome in treating such fractures with PFN. Aim of the Study: Clinical And Radiological Outcome An...
Clinical Outcome of Proximal Femoral Fractures Fixed With Proximal Femoral Nail
Proximal femur fractures are commonly seen in Road Traffic Accident (RTA) and in domestic fall. These fractures behave differently during reduction because of various muscular attachments and difficult to fix. Aim: To evaluate the clinical outcome of proximal femoral fractures fixed with Proximal Femoral Nail(PFN) Materials and Methods: It is a prospective study carried out in our Department of Orthopaedics from Jan 2016 to Jan 2017. Total 15 cases were treated of which 6 were Intertrochanteric fractures and 9 were Subtrochanteric fractures. All the fractures were fixed with Long PFN under fluoroscopic guidance by closed methods. Patients were followed up at 1,2,3, 6 months. Results: All the patients were assessed clinically with Harris Hip score and radiologically with X rays. Of the 15 patients 11 cases went for union, 2 cases went for delayed union and 2 cases of non-union were reported. Out of 11 cases went for union 1 case went for varus deformity, 1 case of shortening was observed. In our study excellent result noted in 60 % of cases, good result in 20 % of cases, fair in 7 % of cases and poor in 13 cases Conclusion: Our study suggest that PFN is a stable implant allows early mobilization, less tissue trauma, less operative time, less blood loss, preserving the fracture haematoma thereby helping the fracture to consolidate early, no thigh pain due to longer nail thereby improving the functional outcome of these proximal femoral fractures.
International Orthopaedics, 2006
Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN). We report here the results of a prospective study carried out at our institute on 100 consecutive patients who had suffered a pertrochanteric, intertrochanteric or high subtrochanteric fracture, or a combination of fractures, between December 2002 and December 2005 and were subsequently treated with a PFN. Close to anatomical reduction of the fracture fragments was achieved in 12 patients, while limited open reduction was required in 14 patients. During the follow-up period of 1 year complications occurred in 12 patients. Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications. Osteosynthesis with the PFN offers the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. Résumé Pour obtenir une fixation stable permettant une mobilisation précoce de nombreux clou intra-médullaires ont été conçus. Le clou proposé par le groupe AO/ASIF en 1996 permet la fixation des fractures per, inter ou sous trochantériennes. Nous avons fait une étude prospective de 100 patients consécutifs ayant une fracture d'un de ces types ou une combinaison d'un de ces types entre decembre 2002 et decembre 2005 et traité par un clou fémoral proximal. La réduction était anatomique chez 86 patients et chez 14 patients un abord limité était nécessaire pour la réduction. Pendant la période de suivi de 1 an, 12 patients avaient des complications.. Nous recommandons une technique chirurgicale précise et adaptée à la fracture. L'ostéosynthèse avec ce clou donne l'avantage de la stabilité rotatoire, n'oblige pas à un alésage et permet un verrouillage distal statique ou dynamique.
International Journal of Research in Orthopaedics, 2020
Background: Trochanteric femoral fractures are often seen in patients aged they can be caused by high-energy or low-energy trauma or may be pathological. Particularly in the elderly, hip fractures are a major cause of increased mortality and morbidity. Because of the decreased physical capacity, concomitant systemic diseases, and increased vulnerability to environmental dangers, even low-energy trauma can cause unstable femoral trochanteric fractures in this age group. Compare the functional outcome of the short proximal femoral nail with a long proximal femoral nail in proximal femoral fractures.Methods: This retrospective study was conducted in the Department of Orthopaedics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu Dist., Tamil Nadu, India. (KIMS & RC). Palmer/Parker score is obtained for the functional outcome of the short proximal femoral nail with a long proximal femoral nail in proximal femoral fractures.Results: It is concluded from ou...
Aims: 1) Evaluation of Effectiveness and strength of Proximal Femoral nail in management of Trochantric and Sub-Trochantric Fractures. 2) Early mobilization and functional recovery of patient Objectives: 1) Stable Internal Fixation designed to fulfill biomechanical demands. 2) Toassist & enhance fracture healing. Method: It is a prospective study carried out from 2008 to 2014 in the Dept. Of Orthopaedics, RMC, Loni. Total 39 cases were treated. Boyd and Griffins classification is used. Majority of cases were from of 5 th-8 th decade of life. Stability of fractures is judged by presence of posterior-medial femoral cortex integrity. In all cases standard 25 mm PFN of 135 0 /130 0 were used. Results: After average follow-up of one year good to Excellent Hip range of motion was seen in 36 cases. All cases showed fracture union. No Z effect seen in any case. Except 2 cases which showed Reverse z effect and in 1 case nail breakage was seen without affecting functional abilities. Average fracture union time was 16 weeks. Conclusion: Proximal Femoral Nail is biomechanically sound fixation, minimally invasive which permits early mobilization, prevents excessive varus collapse at fracture site, produces less stress riser effect below tip of nail. But it also appears from this series that Indications of fixation are limited, excessive Lateral cortex comminution may limit its use. Still Proximal femoral nail is to be time tested to call it as best treatment modality for inter torchanteric & subtrochanteric fractures
Zillur Rahman Siddique et al; Sch J App Med Sci, Nov, 2020; 8(11): 2436-2438, 2020
Objective: In this study our main goal is to evaluate the functional outcome of the treatment of subtrochanteric fracture of femur fixed by proximal femoral nail (PFN). Method: This clinical trial study was conducted at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka January 2017 to June 2018. Results: During the study, 40% of the cases femoral nail was fixed within 10 days of occurrence of fracture, while in rest 60% of cases, fixation was done after 10 days of fracture. The mean interval between injury and nail fixation was 10.9 days and the minimum and maximum intervals were 8 and 13 days respectively. Evaluation of outcome 12 months after nail fixation showed that 80% of the patients had good outcome (Haris Hip Score between 80 - 89) and the rest 20% had fair outcome (Haris Hip Score between 70 - 79). Conclusion: From our study we can conclude that, the proximal femoral nail is a safe and reliable implant for the treatment of subtrochanteric fractures of femur. Majority of the patients return to preinjury activities with mild limitations in hip movement
A prospective study of management of subtrochanteric femur fracture using proximal 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.
International Journal of Orthopaedics Sciences, 2019
Background: Intertrochanteric fractures of the femur are fairly common injuries seen in Orthopaedic practice and have a bimodal age distribution. Various modalities of treatment are available in the management of these fractures. The aim of this study was to evaluate the role of the proximal femoral nail (PFN) in the management of these fractures and to assess the functional outcome using the Harris hip score. Methods: 30 patients with Intertrochanteric fractures of the femur who were willing for surgery and follow up were included in our study and were treated with proximal femoral nail and were followed up for a 3 year period. Results: There was a male preponderance seen in our study with the right hip being more commonly affected. The most common mode of injury was slip and fall followed by road traffic accidents. The mean surgical time was 59.03 minutes and the average time to fracture union was 12.4 weeks. The mean Harris hip score was 83.3 and we had excellent results in 5 patients and good results in 12 of them. Conclusion: Proximal femoral nailing is an effective treatment option in the management of intertrochanteric fractures of the femur and is associated with lesser operating times, minimal blood loss and earlier weight bearing as compared to other fixation methods and rehabilitation of the patients is quite rapid as well leading to a good functional outcome.
Outcome and complications of intertrochanteric femur fractures treated by proximal femoral nail
International Journal of Orthopaedics Sciences, 2019
Purpose: This study was done to report the functional outcome and the complications of intertrochanteric fractures fixed with Proximal Femoral Nail (PFN) in Indian population. Methods: 124 patients with intertrochanteric fractures fixed with PFN and with a minimum follow-up of 4 months were assessed. Functional outcome was calculated using Modified Harris Hip Score (HHS) and Parkers Mobility Score (PMS). Radiological outcome was assessed using hip radiographs and complications encountered during the follow-up period were noted. Results: 117 patients had a good functional outcome with mean HHS of 71.2 and PMS 7.09. During first year, outcome and recovery was better for AO 31A1 and 31A2 fractures (p < 0.05). After one year, no difference was seen in outcome between fracture types. Patients less than 60 years had better outcome than those above 60 years (p < 0.05). Three patients expired during follow-up period. Nine patients had implant related complications with four of them re...