A Comparitive & Prospective Analysis of Unstable Trochanteric Fractures Fixed with PFN and PFN AII

Avinash, M (2020) A Comparitive & Prospective Analysis of Unstable Trochanteric Fractures Fixed with PFN and PFN AII. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Over a period close to a century since, operative treatment of intertrochanteric fractures has begun, it has become the most frequently operated fracture all over the world, and poses critical problems such as high cost of care, sub-optimal functional recovery, higher post-operative mortality and social disability to the elderly population. Also, to the surgeon it poses the risks of loss of stable anatomical reduction, implant failure and early postoperative recovery in these patients. Various modalities of operative treatment have evolved over a period of time and the choices of implants vary with fracture pattern. Proximal Femoral Nailing has evolved as a first line choice of procedure for intertrochanteric and subtrochanteric fractures. In the recent times Proximal Femoral Nailing is being tested with newer advancements such as Antirotation and Anti-rotation II types each having its own bio-mechanical differences for increased stability and both advantages and disadvantages over one another. AIM OF THE STUDY: The aim of the study is to compare and analyse the functional outcome of patients with Unstable Trochanteric fractures managed with Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proxmial Femoral Nailing (PFN). OBJECTIVES: Comparisons in the functional outcome will be made on the objectives such as intra operative time, blood loss, time for union, Hip range of motion, wound and local complications, Harris Hip Score. MATERIALS AND METHODS: This study is a prospective study with a sample of 20 patients with unstable trochanteric fractures of femur. Of this 10 were treated with Proximal Femur Nail (PFN) and 10 treated with Proximal Femoral Nail Anti-rotation II (PFN A II) at Department of Orthopaedics and Traumatology, Govt Rajaji hospital, Madurai. Patients were selected from among the admissions to the Orthopaedic ward in the Department of Orthopaedics and recruited into the study prospectively. RESULTS: Patients were followed up every 2 weeks till fracture united and thereafter at 3 months, 6 months and 1 year. Clinically, tenderness at fracture site, limb length discrepancy, range of movements, deformity were assessed at each follow up and a standard proforma for Harris Hip Score evaluated. The age groups varied from 52 years to 75 years with the mean age of 60 years in patients treated with PFN A II. The age groups varied from 51 years to 67 years with the mean age of 58.2 years in patients treated with PFN. Boyd & Griffin Type II (Unstable type) being the most common in our study constituting 75% of the patients followed by Type IV pattern constituting around 15% and then Type III constitutes 10% of the patients. Time taken for surgery was calculated from the time of skin incision to the closure of the skin. The average time taken for surgery in the group of patients treated with PFN is 91.5 minutes and PFN A II is 65.5 minutes. There is a significant difference statistically between the two groups proven by the p value < 0.05. The average blood loss during surgery in the group of patients treated with PFN is 300ml and PFN A II is 238ml minutes. There is a significant difference statistically between the two groups proven by the p value < 0.05. Union of the fracture is assessed by the Standard Digital Anteroposterior radiograph of the Pelvis with operated hip. The average time of union in weeks for patients operated with PFN is 15.6 weeks and in patients operated with PFN A II is 12.4 weeks. There is a significant difference statistically between the two groups proven by the p value < 0.05. Harris Hip Score (HHS) is calculated with the standard scoring sheet. Patients are asked for the Pain around the hip joint, activities of daily living, range of motion calculated and deformities are assessed if present. Although is a definite difference between the union rate within the two groups it is not statistically significant. CONCLUSION: Incidence of Unstable Intertrochanteric fractures is on the rise and is also compounded by various fracture dependent and independent factors (like Osteoporosis, renal failure etc.) Proximal Femoral Nail (PFN) for the management of these fractures is a time tested implant that stood for a very long time. The recently introduced PFN A II (Proximal Femoral Nail Antirotation II) is found to be equal and sometimes better alternative for PFN in terms of lesser surgical time & faster union rate even though it has comparable functional outcome (as calculated by Harris Hip Score) with PFN.

Item Type: Thesis (Masters)
Additional Information: 221712102
Uncontrolled Keywords: Unstable Trochanteric Fractures Fixed, Proxmial Femoral Nailing (PFN), Proximal Femoral Nailing Anti-rotation II (PFN AII).
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 14:35
Last Modified: 13 Feb 2021 14:35
URI: http://repository-tnmgrmu.ac.in/id/eprint/14107

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