Proximal Femur Nailing for Unstable Sub Trochanteric and Inter Trochanteric Fractures

Syed Bakhar, S (2015) Proximal Femur Nailing for Unstable Sub Trochanteric and Inter Trochanteric Fractures. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION: Treatment of unstable trochanteric fractures is always challenging. Dynamic Hip Screw and Dynamic Condylar Screw have been used for a long time with great success. However both DHS and DCS requires relatively larger skin incision, more tissue handling, all of which increases the probability of infection, blood loss, operating time. Varus collapse of the fracture, non union and implant failure are also commonly seen with DHS fixation. Since this device performed less well in unstable trochanteric fractures,with high rates of failure, intramedullary fixation devices have become increasingly popular.The main principle of this type of fixation is based on a sliding screw in the femoral neck-head fragment, attached to an intra-medullary nail. In 1996 AO/ASIF came up with new cephalomedullary reconstruction nail (Proximal femur nail) with trochanteric entry port. This nail have shown to be biomechanically stronger than DHS fixation and other modalities of fixation. Moreover Proximal Femoral Nail have also reduced the chances of infection, blood loss, morbidity and patients were allowed early weight bearing. MATERIALS AND METHODS: This is a prospective, non randomised control study conducted in Coimbatore Medical College & Hospital. 20 Patients with unstable Inter trochanteric and subtrochanteric fractures who met our inclusion criteria were selected. Clinical assessment of the patients were done in detail. Basic blood investigations were done, X-rays of involved hip with thigh taken. Fractures were classified by Seinsheimers, and Boyd and Griffin Classification. Detailed informed consent obtained. Open reduction done only when not able to achieve closed reduction. Both short and long Proximal femur nail were used depending upon the needs. Post operatively patients were mobilised immediately, full weight bearing started only after radiological union of fracture. Patients were post operatively evaluated with modified Harris Hip Score. RESULTS: In our study, mean age of the patient was 55.18 yrs,6 cases were of type 2 fractures , 4 cases were type 3 A fracture. As assessed by modified Harris hip score, excellent to fair results were obtained at 12 months follow up in 16 cases ,4 cases had poor results. Two patient s had superficial infection, one had deep infection who was treated with i.v. antibiotics. 6 patients had limb shortening of 2 cms, varus malunion seen in one patient with Z effect. CONCLUSION: Proximal femur nail has widened the indication of intra medullary nailing for more complex fractures of the proximal femur. By doing closed reduction ,it offers a minimal soft tissue damage, preserves the fracture hematoma, decreased blood loss and reduces the operating time. Though complications were reported, still it holds good, with good surgical hands because the procedure is technically demanding and needs a steep learning curve.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Proximal Femur Nailing ; Unstable Sub Trochanteric ; Inter Trochanteric Fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 26 Sep 2017 00:59
Last Modified: 26 Sep 2017 00:59

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