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Volume 12 Issue 2 ( April- June) 2023

Original Articles

Assessment of role of proximal femoral nail in unstable trochanteric fractures of femur
Dr. Shivam Kumar, Dr. Priyanjal Jakhar, Dr. Rahul Bade, Dr. Surinder Kumar

Background: Proximal femoral fractures are important cause of morbidity and mortality these days in aged population. This study evaluated the role of proximal femoral nail in unstable trochanteric fractures of femur. Materials & Methods: Fifty cases of trochanteric fracture of femur were examined clinico radiologically and were admitted to orthopaedic ward. Fractures were further classified with AO/OTA classification and unstable type (AO 31 A2, A3) were included in this study. Cases were treated with proximal femoral nail. Following parameters were noted intraoperatively- total time of the surgery and blood loss. Patients were followed up regularly at 1, 2 and 6 months postoperatively and assessment was done using Harris Hip score. Results: 23(46.0%)had right limb involved and 27 (54.0%)had left limb involved. 27 (54.0%) had fall from height, 21 (42.0%) had road traffic accident and 2 (4.0%) had slip and fall. 12(24.0%)had no co-morbidity,11(22.0%)had diabetes,17(34.0%) had hypertension,8(16.0%)had both diabetes and hypertension and 2(4.0%)had asthma. 18(36.0%) had 31–A2.1type of fracture, 17 (34.0%)had31–A2.2typeoffracture,6(12.0%)had31–A2.3typeof fracture,2(4.0%)had31–A3.1 type of fractureand 7(14.0%)had31–A3.2typeof fracture. 23(46.0%)had short PFN implant used and 27 (54.0%) had long PFN implant used. 10 (20.0%) had operative time between 60 – 70 mins, 11 (22.0%) had operative time between 70 – 80 mins, 15 (30.0%) had operative time between 80 – 90 mins and 14 (28.0%) had operative time between 90 – 10 mins. 12 (24.0%) had blood loss of 150 ml, 15 (30.0%) had blood loss of 200 ml, 10 (20.0%) had blood loss of 250 ml, 8 (16.0%) had blood loss of 300 ml and 5 (10.0%) had blood loss of 350 ml in the entire study group. 12 (24.0%) had radiological union between 12 – 13 weeks, 14 (28.0%) had radiological union between 14 – 15 weeks, 7 (14.0%) had radiological union between 16 – 17 weeks, 5 (10.0%) had radiological union between 18 – 19 weeks and 12 (24.0%) had the radiological union between 20 – 21 weeks in the entire study group. The difference was significant (P< 0.05). Conclusion: Proximal femoral nailing is a significant advancement in the treatment of unstable trochanteric fractures. By doing closed reduction, it offers a minimal soft tissue damage, preserves the fracture hematoma, decreased blood loss and reduces the operating time. The proximal femur nail offers a stable fixation, minimizes the stress and allows early mobilization. It offers a superior stabilization than other currently used implants for such fracture. It is mandatory that the fracture must be reduced anatomically with alignment of posteromedial buttress before nail insertion as the nail does not do any spell. Though complications were reported, still it holds good, with good surgical hands because the procedure is technically demanding and needs a steep learning curve.

 
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