A comparative study of functional outcome of Closed Subtrochanteric Fractures managed by Dynamic Condylar Screw and Reconstruction Nail

Karthik Raja, R (2010) A comparative study of functional outcome of Closed Subtrochanteric Fractures managed by Dynamic Condylar Screw and Reconstruction Nail. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Fractures of the femur are commonly encountered in Orthopaedic practice. Of all femur fractures, 7% - 34% occur in the subtrochanteric region1. Subtrochanteric femur fractures have demanded special consideration in Orthopaedic Traumatology, given the higher rate of complications associated with their management. The intense concentration of deforming forces and decreased vascularity of the region have challenged orthopaedicians with problems of malunion, delayed union, nonunion and implant failure. Recently, better understanding of fracture biology, reduction techniques, image intensification and biomechanically improved implants allow for subtrochanteric fractures to be addressed with consistent success. AIM OF THE STUDY: To compare and evaluate the outcome of traumatic Subtrochanteric fractures managed with Dynamic Condylar Screw and Reconstruction Nail at Government Royapettah Hospital / Kilpauk Medical College, Chennai during the period from June 2007 to December 2009. MATERIALS AND METHODS: The purpose of the study is to evaluate the functional outcome of closed subtrochanteric fractures managed surgically in Government Royapettah Hospital/Kilpauk Medical College, Chennai from June 2007 to November 2009. A total of 20 patients were taken up for the study. The pre-requisite for the inclusion in the study was a minimum of 6 months follow-up evaluation period. Reduction was considered acceptable when the anatomic configuration of the hip was restored and continuation of the medial cortex was re-established. If neither of these were achieved, the reduction was deemed unacceptable. Union was defined by radiographic criteria consistent with clinical examination or both. The majority of the patients were operated when their general condition was stable, mostly within a week. Few were postponed for their medical problems or associated injuries. Prophylactic antibiotics were given at the time of skin incision. RESULTS: In our study we have taken 20 patients with 20 subtrochanteric fractures. 10 patients were treated with reconstruction Nail, 10 patients were treated with Dynamic Condylar Screw fixation. Primary bone grafting was done in 4 patients who were treated by open reduction for Seinsheimer type IV and V. Out of 20 cases there were 3 cases (15%) of malunion. One patient in recon nail group and two in DCS group. Many patients have occasional pain. Most of them walk without support. Mostly do their normal activities. Almost all patients have normal muscle power. Nonunion was noted among 3 patients. One in recon nail group and two among DCS group. One failure case in DCS group was due to implant failure secondary to infection for which Implant removal was done and infection control achieved. CONCLUSION: For the successful management of the subtrochanteric fractures reestablishment of medial cortex with maintenance of length and rotation are the most important factors. • Centromedullary devices yield comparable results with DCS and being closed procedure this is a very good option nowadays. • When anatomic reduction is attempted in comminuted fractures where open reduction is done bone grafting is used. • In grossly comminuted fractures, closed ILIM nails such as reconstruction nail gives equally good results without bone grafting. • Despite anatomic reduction the mode of failure in the DCS treated patient was due to lag screw cut out, plate or screw breakage. They are disturb the fracture biology and are prone for delated healing and nonunion. • This study suggests that reconstruction nail is a reliable implant for subtrochanteric fractures, leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages. • But the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive. • Reconstruction nail being a load sharing device, rehabilitation can be started early, DCS fixation being load bearing device may be unstable in fractures with posteromedial communition, delaying rehabilitation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: comparative study ; functional outcome of closed subtrochanteric fractures ; management ; dynamic condylar screw ; reconstruction nail
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:17
Last Modified: 17 Sep 2017 16:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/2979

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