Outcomes of Proximal Femoral Nail in Subtrochanteric Femur Fractures Through Medial Entry
Journal Title: TRAUMA INTERNATIONAL - Year 2018, Vol 0, Issue 0
Abstract
Introduction: Subtrochanteric Fractures Of Femur accounts for 10-34% of all hip fractures.Several Methods of treatment of this Fractures have been reported like DHS( Dynamic hip screw),Angled blade Plate,Proximal Femur Locking Plate and Intramedullary devices. Currently Intramedullary Devices like Proximal Femur Nail are used by many giving Satisfactory results in subtrochanteric femur fractures. In such situation as Suggested by Richardu et. al. [7] slight medial entry leads to valgus alignment which is desired along with the anatomical reduction while nailing subtrochanteric fractures. In the study conducted by perez et al. Suggested that slight more medial entry also protected abductors and caused no damage. Purpose of the study: The purpose of this study is to evaluate the results of subtrochanteric femur fractures treated with long proximal femur nail with entry medial to the tip of greater trochanter from 2014 -2016 treated at VSGH Materials and methodology: • Permission from ethical committee was taken • Patient data is collected from OOT register VSGH from 2014-2016 • All the patients of subtrochanteric femur fractures treated with long proximal femur nail through medial entry will be called for follow-up and data is collected as per the performa. Patients were followed up at 2 ,4 ,6 weeks and then monthly with clinical and radiographic assessment until fracture union.fracture union was considered when bridging callus was visible on 3 of 4 cortices on anteroposterior and lateral radiograph. Functional assessment will be done using Harris Hip Score. Discussion: utilizing the tip of the trochanter as a starting point led to both varus and valgus malalignments [26] Using the Trochanteric Fixation Nail (TFN) with a lateral to the tip of the trochanter, starting point demonstrated 6.83° varus and a gap of 8.03 mm. A medial starting point resulted in 6.6° valgus with a mean gap of 3.88 mm and a tip starting point showed 0.3° varus and 3.56 mm of gapping26 Streubel PN [27] In his study concluded that the ideal entry point ranged from 16 mm medial to 8 mm lateral to the trochanteric tip (mean, 3 mm medial; standard deviation, 5 mm). In 70% of patients, the ideal entry point was medial to and in 23% lateral to the tip of the greater trochanter and the trochanteric tip represents the ideal starting point in only the minority of cases. Prasarn [28] in his study concluded that rigid femoral nails introduced through a lateral entry portal have been associated with a higher risk of iatrogenic fracture and malreduction. In the above conducted study, there was a valgus angulation at the proximal femur due to medial entry of the proximal femur nail Conclusion: This study was conducted to analyze the results of Subtrochanteric fractures treated with this Proximal Femoral Nail through medial entry both radiological and functionally. In our series of 30 cases of Subtrochanteric fractures treated with Proximal Femoral Nail, 24 patients had Excellent to good outcome at their final follow-up. Poor outcome was seen in 02 patients. 2 of these patients had poor reduction intraoperatively. The mean Harris Hip score at their final follow-up was 80.76 which is comparable to international publications in the literature. On follow-up radiological examination at 6 months 10 patients had 2-4 degrees of valgus angulation,16 patients had 4-6 degrees of valgus angualtion and 4 patients had 6-8 degrees of valgus angulation with no varus collapse. From this sample study, we conclude that Proximal Femoral Nail through medial entry is a good method for the treatment of Subtrochanteric fractures of femur provided optimal reduction of the fracture and good positioning of the nail and screws are achieved.
Authors and Affiliations
Rohan R Memon, Neel M Bhavsar, Rameez A Musa, Pankaj R Patel
Keywords
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