Intramedullary Fixation of Unstable Peritrochanteric Fractures with Interlocking Proximal Femoral Nail: A Prospective Analysis

Alfred Sathiya Sekar, S (2007) Intramedullary Fixation of Unstable Peritrochanteric Fractures with Interlocking Proximal Femoral Nail: A Prospective Analysis. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: In unstable trochanteric fractures where there is loss of posteromedial cortex continuity, when load is applied increased bending force on the DHS lead to implant breakage, screw cutout or separation of plate from shaft. This lead to the introduction of Intramedullary devices which theoretically due to its position provides more efficient load transfer and shorter lever arm can decrease tensile strain thereby decreasing the risk of implant failure. Though Zickel introduced his nail long ago it was not very popular due to higher incidence of complications, so was the case with ender’s nail. Zickel nail was later modified and renewed interest is being given to intra medullary fixation with devices like the IMHS (intra medullary hip screw), Gamma nail, Russell – Taylor reconstruction nail, ATN ( Ante grade trochanteric nail), TFN (Trochanter fixation nail) and the PFN (Proximal femoral nail) due to advantages of reduced operating time, less blood loss, better biomechanical stability and earlier mobilization provided by this devices. In 1997, PFN (Proximal femoral nail) was introduced in Czechoslovakia by Synthes company which has the biomechanical advantage of all IM devices and considered to be as a second generation nail. Several recent studies are going on for comparison with DHS and other IM devices and the results are encouraging but needs time and further evaluation to be accepted. AIM OF THE STUDY: To assess the effectiveness of Intramedullary fixation of unstable peritrochanteric fractures with interlocking proximal femoral nail. MATERIALS AND METHODS: At our institution we selected 21 cases of peritrochanteric fractures for this prospective study. All 21 cases were treated with proximal femoral nail (indigenous) of which 20 patients came for regular follow up and they were included in the study. The age group varied from a minimum of 32 years to a maximum of 72 years and average age was 52.7 years. The duration of the study was from June 2004 to June 2006. The mean follow up was 10.75 months. Of the 20 patients 14 were males and 6 were females. Right side was involved in 7 patients and in 13 patients the left side was involved. 13 patients were sedentary workers and 7 patients were manual laborers. All the fractures were classified according to the Boyd and Griffin classification for peritrochanteric fractures. 11 patients were classified as type II, 4 patients were classified as type III, 5 patients were classified as type IV. All of them are unstable trochanteric fractures. RESULTS: The operating time was calculated from the start of surgical incision to wound closure. In the initial cases our operating time was on the higher range, with experience the operating time reduced. Operating time varied from 58 to 84 minutes. The blood loss was calculated from the number of surgical mops that were used, each corresponding to 50 ml blood. Blood loss varied from 150 to 350 ml. The average blood loss was 230 ml. The duration of image intensifier usage was calculated in seconds. CONCLUSION: Intra medullary nailing with PFN as claimed has distinct advantages over DHS like reduced operating time, less blood loss, rigid fixation and positive effect on the speed of restoration of walking. It also has advantage over Gamma nail in rotational stability of proximal fragment and reduction in the complication rate of femoral shaft fractures. The incidence of per operative and post operative femoral shaft fractures can be reduced by pre-reaming the shaft one size more than the diameter of the nail and by distal locking meticulously without creating additional stress risers. The incidence of cutout of cervical lag screw can be reduced by optimal reduction of the fracture and accurate positioning of cervical lag screws and nail. Finally, we conclude that the PFN is a significant advancement in the treatment of unstable peritrochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective Analysis ; Intramedullary Fixation ; Unstable Peritrochanteric Fractures ; Interlocking Proximal Femoral Nail.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:42
Last Modified: 17 Sep 2017 14:04

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