Functional and radiological outcome of pertrochanteric fracture in elderly patients treated with dynamic hip screw or proximal femoral nail: A prospective study

Ramesh, B (2014) Functional and radiological outcome of pertrochanteric fracture in elderly patients treated with dynamic hip screw or proximal femoral nail: A prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Pertrochanteric fractures is one of the most commonest fracture in orthopaedics. There is an increase in the incidence of this fracture now due to road traffic accidents, constructions works and rise in elderly population. Appropriate treatment early mobilization of patients are must to prevent morbidity and mortality due to fracture disease. Pertrochantric fractures were treated in the past with prolonged traction and then mobilization which leads to shortening and deformity of limb along with morbidity and mortality due to prolonged traction. Then comes the operative treatment of this fracture using fixed angle devices with the drawback of more complications. Dynamic hip screw with advantage of controlled impaction with less complications were introduced which is the implant of choice in stable pertrochanteric fracture .The complications with dynamic hip screw in unstable pertrochanteric fracture was more than stable fracture. Intramedullary devices were introduced with the aim of minimizing the complications in unstable fracture fixation. AIM: The aim of the study was to assess the functional and radiological outcome of pertrochanteric fracture in elderly patients treated with dynamic hip screw or proximal femoral nail. MATERIAL AND METHODS: The study was conducted in Government Royapettah hospital, from May 2012 to December 2013. 20 cases of pertrochantric fractures admitting in casualty was evaluated for inclusion criteria. Patients with age over 55 years were include in our study and patients with pathological fracture were excluded. The 20 patients were divided into stable and unstable groups using Evans classification. DHS was done for 10 of them and PFN for another 10 of them and results were evaluated. OBSERVATION AND RESULTS: Most of the patients in our age group were between 55 to 65 years around 80% .Males predominate in our study by 70% left sided fracture more in our study. The mean duration of surgery, mean blood loss and mean length of incision was more in DHS group then PFN group. We came across more intraoperative complications in PFN group then DHS group. Time of weight bearing was more in unstable fracture in DHS group. The Harris hip score was in favor of PFN at six weeks after surgery but it became same in both groups after 20 weeks of surgery. DISCUSSION: Intertrochanteric fracture is a challenge to orthopaedic community besides achieving union the need here is the restoration of optimal function in shortest period with minimal complications. This can be achieved by stable fixation with correct implant. CONCLUSION: PFN has advantage of smaller incision, less blood loss and less morbidity. The short lever arm and lower bending moment in PFN may add mechanical advantage to the construct which makes it the implant of choice in osteoporotic bones. Deformity and complications was less in PFN group in our study. Rate of fracture union was similar in both groups with early mobilization in PFN group, DHS found to be the implant of choice as for as stable fracture is concerned but for unstable fracture the pendulum swings in favor of PFN.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pertrochanteric fracture ; Dynamic Hip Screw ; Proximal Femoral Nail ; Harris hip score.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 19:15
Last Modified: 16 Sep 2017 19:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/2995

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