Abstract: Background and Objectives:
Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly. These fractures are three to four times more common in women and the mechanism of injury is usually due to low-energy trauma like a simple fall. More than 50% of intertrochanteric fractures are unstable. The surgical stabilization of unstable intertrochanteric fractures remains a persistent challenge. The purpose of this dissertation is to study the effectiveness and drawbacks of one such newer intramedullary device, the Proximal Femoral Nail in the management of unstable intertrochanteric fractures
Methodology: This study is a prospective, time bound, hospital based study conducted at P.G.I of swasthiyog Pratishthan, Miraj, between March 2013 to Feb 2014. The study included 45 cases of unstable intertrochanteric fractures (AO classification 31A2 & 31A3) that were operated with the PFN which fitted into the inclusion criteria. All patients were informed about the study in all aspects and an informed consent was obtained. Follow up at 4, 8, 12, 18, 24 weeks for serial clinical and radiological evaluation was done and assessed clinically regarding pain, limp, hip movements, walking ability, deformity and shortening. Functional evaluation at end of 6 months was done by using Harris hip score.
Results: The study included 45 cases of unstable intertrochanteric fractures (36 cases of 31A2 & 9 cases of 31A3) that were operated with the PFN. The average age was 64 years. The most common mode of injury was trivial fall in 30 cases. Good reduction was achieved in 39 patients (86.66%). Acceptable reduction was achieved in 6 patients. 3 intraoperative complications and 9 post-operative complications observed. The average time of union was 18.44 weeks. Maximum number of fractures united between 16-20 weeks. Good to excellent results were seen in 88.8% of the cases according to Harris hip score at end of 6 months.
Conclusion: Hence we conclude that short Proximal Femoral Nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed, leading to high rate of bone union and minimal soft tissue damage especially for asian patients with relatively small femora.