A Prospective Study of Functional Outcome in Subtrochanteric Femur Fracture Fixation Using Long Proximal Femoral Nail

Ramesh Kumar, S P (2020) A Prospective Study of Functional Outcome in Subtrochanteric Femur Fracture Fixation Using Long Proximal Femoral Nail. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Subtrochanteric fractures of the femur account for approximately 10-30% of all Hip fractures. Subtrochanteric fractures of the femur present a challenge for treatment because of the deforming forces on the proximal and distal segments which are difficult to control as the proximal segment is inherently short, decreased vascularity of the region, unfavourable fracture morphology (comminution), strong deforming muscle forces, difficulty in attaining and maintaining reduction during surgery and complications of varus malunion, implant failure, infection and non union, subtrochanteric fractures of the femur pose a great challenge to the orthopaedic surgeon. Nowadays because of the better understanding of the fracture biology, availability of image intensifiers, newer tricks in reduction methods, availability of biomechanically stable implants and monitored post-operative rehabilitation programs, these fractures are better treated with good patient outcomes. AIM OF THE STUDY: To evaluate the functional outcome in Subtrochanteric femur fracture fixation with long proximal femoral nail in Govt Stanley Hospital, Chennai from June 2017 to September 2019. MATERIALS AND METHODS: The idea of the study is to evaluate the Functional outcome in Subtrochanteric femur fracture fixation using long proximal femoral nail in patients attending the Dept of Orthopaedics in Govt Stanley Medical College, Chennai from July 2017 to July 2019 after getting institutional ethical committee clearance. During the above mentioned period of 2 years, 20 patients with Subtrochanteric femur fractures were treated with closed/open reduction and fixed with Long proximal femoral nail. All the data required for the studywere collected from the patients after getting proper consent from them during their stay in the hospital and at regular intervals during their followup visits and from the medical records. Inclusion Criteria: 1. The fracture line located within 5 cm below the lesser trochanter, 2. Skeletally matured patients of either sex, 3. Closed fractures, 4. Interval from injury to operation < 3 weeks. Exclusion Criteria: 1. Skeletally immature patients, 2. Open fractures, 3. Old fractures > 3 weeks, 4. Pathologic fracture, 5. Patients medically unfit for surgery. RESULTS: We have included 20 patients with subtrochanteric fracture of the femur in our study. Most of the patients are in their third and fourth decade of life with RTA being the major mode of injury. Males are affected most commonly than the females. Being suffered the high energy mechanism injury, most of the patients had associated other system injuries and fractures of the other regions. 15 out of 20 patients suffered injury on their right side and most of them classified under Seinsheimer type 3A and 3B, 3 patients classified under Seinsheimer type 4 and 1 patient being classified under type 5. 8 patients were treated with closed reduction and long proximal femoral nail and 12 patients required open reduction of the fracture fragments with some being offered mini open techniques. CONCLUSION: For the successful management of the subtrochanteric fractures of femur, accurate restructuring of the medial cortex is of paramount importance to render the fracture stable. The reduction technique could be closed/open/mini open. These fractures fixed using long proximal femoral nail have a stable construct which allows us to mobilize these patients early with less hospital stay and early weight bearing. The longer the nail, more the working length across the fracture site and less the chances of varus malunion. Majority of the patients in our study had good to excellent functional outcomes following fixation with long proximal femoral nail. We encountered complications in 3 patients such as superficial surgical site infection, slight varus and delayed union all with good functional outcomes.

Item Type: Thesis (Masters)
Additional Information: 221712057
Uncontrolled Keywords: Functional Outcome, Subtrochanteric Femur Fracture Fixation, Long Proximal Femoral Nail.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 14:07
Last Modified: 13 Feb 2021 14:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/14103

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