A comparative study of functional outcome of short proximal femoral nail with long proximal femoral nail in proximal femoral fractures (original) (raw)
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International Journal of Research in Orthopaedics, 2017
Although surgical stabilization of unstable inter trochanteric femur fractures have become popular in view of complications related to confinement to bed following conservative management, the ideal implant for surgical stabilization of the same, however, is still a debate. 1 Dynamic hip screw (DHS) was considered as the gold standard for most of the inter trochanteric femur fractures. 2 However, in unstable trochanteric fractures, it is associated with high complications (15-21%) like varus collapse, screw back out and cut out of implant from femoral head. 2,3 In view of this, intra medullary devices like proximal femoral nail are becoming popular. 3 Theoretically, biomechanical advantages of intramedullary nail over screw and plate fixation are attributed ABSTRACT 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 legged 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 legged 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 cross legged 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.
International Journal of Research in Pharmaceutical Sciences, 2020
Intertrochanteric fractures constitute one of the most typical fractures of the hip. The incidence of fractures in the trochanteric area has risen with an increase in numbers of the older person with osteoporosis. Mortality, morbidity ratios are increasing in patients with inter-trochanteric fractures. Advanced age and associated co-morbidities are two primary added source for high mortality in trochanteric fracture patients. We conducted this study to assess the mortality rate and the functional outcome in inter-trochanteric fractures after proximal femoral nailing. This is a prospective study, in which 60 Intertrochanteric fractures of femur patients who came to our hospital EMS. Inclusion and Exclusion criteria were included in this study and were done from a period from January 2014 to July 2017. They were evaluated on each follow-up clinically using Harris Hip score and radio-logically using RUST score. The overall mortality rate at the end of the 3-year follow-up in our study ...
International Journal of Research in Orthopaedics, 2020
Background: Intertrochanteric fractures femur in elderly population are more commonly forbidden high morbidity. The surgical stabilization together with early rehabilitation is the main challenge. The elderly population have poor bone mass quality and also the chances of complications like nonunion or implant failure are more with conventional procedures. Stable fixation and early rehabilitation is the main aim in intertrochanteric fractures. The aim is to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population.Methods: The study includes 40 patients, 30 male and 10 female, with fracture intertrochanteric femur treated with TFN from September 2018 to May 2019 at Yashoda Superspeciality Hospital, Nehrunagar, Ghaziabad. The patients were evaluated at 4, 8, 12 weeks postoperatively and assessed by the Modified Harris hip score. Classification used is AO classification.Results: The mean age of patients was ...
International Journal of Research in Orthopaedics, 2018
Hip fractures are nowadays a part of medical emergency in the elderly constituting major reason for hospital admissions and consuming finances. They are further complicated by their major occurrence in the elderly population, who in turn suffer from co-morbid medical conditions making the task of ease of management of such fractures difficult for the treating orthopaedic surgeon. From the evolution of orthopaedic implant in the medical industry a vast inventory of devices was and is available to treat and fix the hip fractures. Of the different types of hip fractures, subtrochanteric fracture constitutes a challenging variety to treat. Subtrochanteric fractures comprise 10% to 34% of hip fractures. 1 The incidence of these subtrochanteric fractures have increased in the young population in India due to vast increase in motor vehicle use and good roads leading to increase in high velocity trauma. Pertrochanteric and subtrochanteric fractures of femur possess clinical, structural, anatomical and biomechanical characteristics that distinguish them from intracapsular fractures. They are complicated by malunion, delayed union and nonunion. These complications are due to high stress concentration, ABSTRACT Background: Subtrochanteric fractures are devastating injuries that not only affect the elderly but also the young. Despite marked improvement in implant design, surgical technique and patient care; subtrochanteric fractures continue to consume a substantial proportion of our health care resources. Methods: This prospective study consists of 20 adult patients of subtrochanteric fractures of femur, who were treated with internal fixation using PFN. All patients were followed up at an interval of 4 to 6 weeks till fracture union and then once in 3 months till 1 year. Results: Anatomical results are noted as good or poor depending upon shortening, varus deformity, hip movements and knee movements and functional result as excellent, good, fair and poor depending upon the hip pain, ambulatory status, ability to squat, and sit cross leg. In the study 2 patients had shortening of l cm. None of the patients had any varus deformity. Overall excellent to good results were achieved in 85% cases. Conclusions: The potential advantages of the proximal femoral nail over extramedullary devices with regards to minimal invasiveness due to closed technique and minimal soft tissue dissection, better biomechanical design to prevent implant failure and ability to bear more stress, shows that this technique holds considerable promise in complex fractures. Early rehabilitation, less blood loss, less surgical trauma, cosmetic incision, make it the implant of choice in complex, comminuted unstable subtrochanteric fractures in adults.
International Journal of Research in Orthopaedics, 2017
Background: Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.Methods: It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment.Results: In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 ca...
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
2016
Introduction: Intertrochanteric fractures are one of the most common fractures of the hip and have been recognized since the time of Hippocrates. The incidence of intertrochanteric fracture is rising because of increasing number of senior citizens with osteoporosis and also the increasing number of road traffic accidents. For stable intertrochanteric fractures dynamic hip screw was accepted as the gold standard. For unstable fractures intramedullary has been preferred recently. In this study we look to compare two types of intramedullary nails for unstable intertrochanteric fracture. Aim of the StudyTo compare the functional outcome of Intertrochanteric fractures treated with Trochanteric fixation nail versus Short proximal femoral nail. Materials & MethodsA prospective study done at the Department of Orthopaedics, Rajah Muthiah Medical College & Hospital, Annamalai University, Chidambaram. Patient with Intertrochanteric fractures were treated with TFN and short PFN. Follow up was d...
International Journal of Research in Orthopaedics
Background: Proximal femoral fractures are one of the most common fractures occurring in elderly due to osteoporosis and increase in life expectancy. The management of these fractures poses a serious challenge in terms of obtaining a stable fixation and a good post-operative outcome. In this study, we compare two intramedullary devices: Proximal femoral nail (PFN) and proximal femoral nail anti-rotation (PFN-A), used commonly for the fixation of proximal femoral fractures.Methods: Patients presenting with inter-trochanteric fractures were included and randomly allocated to two groups for treatment with either PFN or PFN-A. Pre-operative radiographs of normal side were used to grade osteoporosis by Singh’s index. Post-operative radiographs were used to assess the tip-apex distance and quality of reduction. Functional outcome was compared on the basis of Harris hip score at final follow-up. Patients were followed up at an interval of 1, 3 and 6 months respectively.Results: The study i...
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...