Functional outcome of proximal femoral nailing in intertrochanteric fractures: A prospective study

Abstract

Background: The study was conducted to assess clinical and functional outcome of Proximal Femoral nailing in intertrochanteric fractures and to determine the rate of union, complications, operative risks and co morbidities associated with intertrochanteric fractures. Intertrochanteric fractures form around half of the total hip fractures in the elderly and pose a number of management dilemmas depending on the fracture configuration and status of the bones. There are numerous implants available for the internal fixation of these fractures ranging from dynamic hip screw which can be combined with trochanteric stabilisation plate; locking plates; intramedullary implants such as proximal femoral nail (PFN), trochanteric femoral nail (TFN) and Gamma nail. Materials and Methods: The fractures were classified according to BOYD and GRIFFIN classification system. 40 patients of intertrochanteric fractures fulfilling the inclusion and exclusion criteria, were managed surgically using Proximal Femoral Nail. The results were analyzed according to age, type of fracture, operative details and functional outcome using KYLE’s criteria. Results: Totally 40 patients with intertrochanteric fractures were operated with PFN and were included in the study. The mean age of the patients was around 68 years with minimum age being 52 years and the maximum being 88 years. The mean duration of operation was recorded to be 54.59 min. Complications in this study were seen in 3 patients (8%). Complication was surgical site infection 2 patients (5%), greater trochanteric fracture 1 patient (2.5%). Conclusion: The proximal femoral nail acts as a buttress to prevent medialisation of the shaft & provides more effective load transfer. It has a chance of failure in the comminuted and severely osteoporotic fractures. It is superior implant for both stable & unstable fractures. It also has advantages of having decreased blood loss, decreased operating time, decreased complication rates.