A STUDY OF SURGICAL MANAGEMENT OF INTERTROCHANTERIC FRACTURE USING PROXIMAL FEMORAL NAILING

Dr. Raja pandian.R; Dr. Venkatesh.D

Volume : VI, Issue : IV, April - 2017

A STUDY OF SURGICAL MANAGEMENT OF INTERTROCHANTERIC FRACTURE USING PROXIMAL FEMORAL NAILING

Dr. Raja Pandian. R, Dr. Venkatesh. D

Abstract :

AIM AND OBJECTIVE:

� Intertrochanteric femoral fractures are among the most often encountered fractures by Orthopaedic surgeon . Many operative implants are available for the management but none has been satisfactory. The Dynamic Hip Screw has been consi dered the implant of choice because the fracture union predictabl y occurs . A problem with Dynamic hip screw is loss of hip offset and shortening. So the PFN was designed by AO -AS IF group in 1997 for treatment of proximal femoral fracture . PFN being an intramedullary nail is positioned closer to the mechanical axis of femur and therefore is subjected to smaller bending moment than laterall y placed plate and screw devices . The short lever arm also decreases tensile strain on the implant there by reducing risk of implant failure. Additional anti rotational screw increases the rotational stabilit y of the head - neck fragment . This prospective study is to anal yse the outcome of treatment of Intertrochanteric fractures with Proximal Femoral Nail .

MATERIALS AND METHODS: This prospective study comprises of 40 cases of Intertrochanteric fractures that fitted into the inclusion criteria were operated in our institution

Our institution is situated in semi urban area with a rural background . Patients often come to the institution after trying other modalities of native treatment . The study was basically conducted to find out the age incidence, sex distribution, side incidence, mode of injury, fracture anatomy, the operative technique itself and the results obtained and complications if any . Following inclusion and exclusion criteria were used .

RESULTS: This prospective study was conducted in our institution, 56 cases of trochanteric fractures were in the study out of which 11 patients were operated with DHS, 3 patients went agains t medical advice refusing operative treatment, 2 patients were considered unfit for surgery due to high co - morbidities . So 40 cases of intertrochanteric fractures were operated during the above period, which comprises this study

CONCLUSION: In our experience use of PFN in the treatment of Intertrochanteric fractures produces better results. Although surger y is technicall y demanding with need of C -arm & fracture table the outcome was good. It is more biological, aesthetic friendl y & can be done in elderl y patients with Intertrochanteric fractures with co - morbidit y. Good anatomical reduction with posteromedial cortical contact & placement of screws as discussed will prevent complications like varus collapse, Z - effect & shortening. Also the size of incision, time of surgery & blood loss is much less. Recovery is faster with return to functional abilit y at the earliest .