A prospective study on short term functional outcome analysis of management of Ipsilateral combined fractures of femural neck / intertrochanteric and fracture shaft of femur using reconstruction nail

Stanley Michael, J (2013) A prospective study on short term functional outcome analysis of management of Ipsilateral combined fractures of femural neck / intertrochanteric and fracture shaft of femur using reconstruction nail. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Ipsilateral fractures of the femoral neck occur in 2% to 6% of patients with femoral shaft fractures. Ipsilateral hip and femoral shaft fractures are problematic because of their high complication rates. These bifocal femoral fractures are usually encountered in young patients. They are associated with high velocity injuries. They are usually accompanied by multisystem involvement. Despite the rule of taking x-rays of the pelvis for all femoral fractures, we still see cases where femoral fractures are managed without diagnosis of femoral neck fractures. The incidence of missed injuries, notably fractures of the femoral neck is significant. They are reported to range between 20-30%. Early recognition of this injury is required to prevent the inherent disabling complications like non union or avascular necrosis of head of femur. AIM: To analyse the short term Functional Outcome of the management of combined ipsilateral fractures of the femoral neck/intertrochanteric fractures and fractures of the shaft of femur using reconstruction nail, done in our Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital between the period of June 2010 and December 2012. MATERIALS AND METHODS: This is a prospective study of 20 patients done to assess the functional outcome of management of ipsilateral fractures of femoral neck/ intertrochanteric fractures associated with femoral shaft fractures, treated by Reconstruction nail from June 2010- December 2012 at the Institute of Orthopaedics and Traumatology, Madras medical college and Rajiv Gandhi Government general hospital, Chennai. Patients with combined ipsilateral traumatic femoral neck/intert-trochanteric and shaft fractures were included. Single fractures, pathological fractures, open fractures, co-morbid patients were excluded. Patients were admitted through accident and emergency department after due counselling regarding the procedure, its implications, ethical issues and consent for surgery. Inclusion Criteria: The inclusion criteria of the patients were, Patients aged above 15 years, patients with combined ipsilateral fractures of the femoral neck and shaft, Patients with combined ipsilateral fractures of the femoral shaft and intertrochanteric fractures of femur, Patients who consented for surgery. Exclusion Criteria: The exclusion criteria were, Patients aged less than 15 years, Isolated shaft fractures, Isolated femoral neck fractures, Isolated intertrochanteric fractures, Pathological fractures, Open fractures, Patients with co-morbidities. RESULTS: Twenty patients with ipsilateral combined fractures of the femoral neck /intertrochanteric and femoral shaft were treated surgically with reconstruction nail and analysed with average follow up of 13 months ranging from 6 months to 2 ½ years. 17 patients (85%) belonged to 3rd and 4th decade. 10 patients (50%) were in the 3rd decade and 7 (35%) patients in the 4th decade. All the patients in our study were males. Fall from height formed the major form of injury in 80% of patients. There were no cases in which the neck fracture was missed at initial diagnosis. Of the proximal femoral fractures 2 were undisplaced basicervical, remaining 18 were displaced fractures; there were 3 basicervical displaced fractures, 14 transcervical displaced fractures, and 1 intertrochanteric fracture. Eight patients had associated other skeletal injuries. One patient had head injury and orbital fracture; and one patient had rib fracture and haemothorax. In contrast to pelvic injuries, all patients were hemodynamically stable at the time of admission. In our study the average surgical time delay was 18 days ranging from 7 to 49 days. CONCLUSION: In our short term study of 20 patients, we were able to obtained satisfactory results with minimum complication rate. With improvement in surgical experience, we can be able to reduce the operating time and the need for opening up the fractures, in order to achieve reduction which will further produce better results. Hence, we conclude that reconstruction nail is a good option for Winquist 0 and 1 grades of comminution at the femoral shaft fracture, but the functional outcome could be different in patients with marked displacement and higher grades of comminution at shaft fracture site. The results could be improved with further experience and learning and needs further evaluation. Surgeon’s experience in managing these complex injuries cannot be over emphasized. Long term follow up of these patients is required to report on long term complications like avascular necrosis which may result due to the delayed surgical time interval.

Item Type: Thesis (Masters)
Uncontrolled Keywords: prospective study ; short term functional outcome analysis ; management ; Ipsilateral combined fractures ; femural neck ; intertrochanteric and fracture shaft ; femur ; reconstruction nail.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 08:34
Last Modified: 27 Mar 2020 07:22
URI: http://repository-tnmgrmu.ac.in/id/eprint/3171

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