Functional Outcome of Subtrochanteric Femoral Fractures Fixation by Proximal Femoral Locking Compression Plate.

Abstract

Subtrochanteric femoral fractures are one of the common fractures encountered in today's Orthopaedic practice. This area consists of mostly cortical bone with high stress generation thus heal slowly which leads implant failure. The inherent instability of this fracture and forces of the muscles with comminuted medial calcar is giving the fracture a tendency to varus collapse. Intramedullary nails are not suitable for short proximal segment and wide medullary canal while extramedullary implants are associated with higher rate of implant failure. Recently proximal femoral locking compression plate (PF-LCP) has been applied in treatment of proximal femur including subtrochanteric fractures. It has an excellent functional outcome in respect of Weight bearing, Knee ROM, Pain status, Walking, Squatting and Return to pre-injury state. The aim of this study was to assess functional outcome of subtrochanteric femoral fractures fixation by PF-LCP. This prospective study was conducted from March 2019 to September 2020 at Mymensingh Medical College Hospital through non randomized purposive sampling. Total 25 patients aged above 18 years irrespective of sex with closed subtrochanteric fracture were included but pathological fractures, multiple injuries were excluded from the study. They were evaluated by Modified Harris Hip Score (MHHS). Age was ranged from 22 to 70 years and mean age 42.04±14.97 years. Maximum patients (56.0%) were in workable age (21-40 years) and Seinsheimer type III (48.0%) was most common fracture type. Minimum follow up was at least 24 weeks and mean 41.12±7.11 weeks. Functionally most of patient started early partial (88.0%) and full (64.0%) weight bearing with 64.0% have full knee ROM, 52.0% found pain free and 76.0% without limb shortening. Maximum patients regained walking (76.0%) and squatting (68.0%) and return to pre-injury state (72.0%) of activities. Evaluation of functional outcome by Modified Harris Hip Score showed 56.0% excellent, 32.0% good, 8.0% fair and 4.0% poor functional outcome. Excellent and good outcome were considered as satisfactory, thus satisfactory outcome were 88.0%. This study concludes proximal femoral locking compression plate (PF-LCP) is a safe and reliable implant for the treatment of subtrochanteric fractures with excellent functional outcome.