Mallikarjuna Reddy, Raghukumar J, Prajwal GS*, Vijaykumar K and Rajendra Pranav Prasad

Department of Orthopaedics, JJM Medical College, Davangere, Karnataka, India

*Corresponding Author: Prajwal GS, Junior Resident, Department of Orthopaedics, JJM Medical College, Davangere, Karnataka, India.

Received: August 09, 2021; Published: September 06, 2021

Abstract

Background: Intertrochanteric femoral fractures are of more interest globally. Understanding biomechanics of these fractures and the development of implants had led to the various treatment modalities for these patients. The primary goal of surgical management is to provide the anatomical restoration of the normal abductor-lever-arm mechanism of the hip joint. Rigid intramedullary nailing has been suggested as a treatment option in these patients with intertrochanteric fractures due to the perceived advantages of stable fixation with higher union and low complication rates.

Objective: To prospectively review, collate and evaluate the functional outcome, advantages, union rate and complications of intertrochanteric fractures in adults using trochanteric fixation nail.

Materials and Methods: A prospective cohort study with 43 adult patients with intertrochanteric fractures were treated with trochanteric fixation nailing in JJM Medical College, Davangere between 2018 to 2020. The fractures included in the study were classified according to Boyd and Griffin classification. All the cases were followed at regular intervals as per our study protocol. The functional outcome were assessed with Modified Harris’ Hip Score.

Results: In our study, we managed 43 intertrochanteric fractures by trochanteric fixation nailing. The mean radiological union of trochanteric fractures were 12.74±3.12 weeks. The functional assessment were made with Modified Harris Hip scores which were excellent in 23 cases (53.48.48%), good in 14 cases (32.55%), fair in 4 cases (9.30%) and poor in 2 cases (4.65%). No case of helical blade cut out, Z effect and reverse Z effect were reported in our study.

Conclusion: The load sharing device, trochanteric fixation nail (TFN), decrease the patient related morbidity during intra and post-operative period in intertrochanteric fractures and improve the functional status of the patients.

Keywords: Trochanteric Fixation Nail; Intertrochanteric Fractures; Boyd and Griffin

References

1. Karakus O., et al. “The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly”. Journal of Orthopaedic Surgery and Research1 (2018): 207.
2. Gupta RK., et al. “Unstable trochanteric fractures: the role of lateral wall reconstruction”. International Orthopaedics1 (2010): 125-129.
3. Rozell JC., et al. “Recent advances in the treatment of hip fractures in the elderly”. F1000Research 5 (2016).
4. Dougherty PJ. “CORR Insights TM Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures”. Clinical Orthopaedics and Related Research4 (2013): 1387-1378.
5. Zhang Y., et al. “Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis”. Orthopaedics and Traumatology: Surgery and Research 5 (2017): 685-690.
6. Queally JM., et al. “Intramedullary nails for extracapsular hip fractures in adults”. The Cochrane Database of Systematic Reviews 9 (2014): CD004961.
7. Gadegone WM and Salphale YS. “Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year”. International Orthopaedics 3 (2007): 403-408.
8. Van Leur JPH., et al. “Trochanteric Fixation Nail® with Helical Blade Compared with Femoral Neck Screw for Operative Treatment of Intertrochanteric Femoral Fractures”. Hip Pelvis 1 (2019): 48-56.
9. Shin WC., et al. “Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?” Hip Pelvis 2 (2017): 104-112.
10. Gardner MJ., et al. “Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail”. Injury10 (2007): 1189-1196.
11. Mohammed Ibrahim., et al. “Intertrochanteric fracture treated with TFN (trochanteric femoral nail): A clinical study”. International Journal of Orthopaedics Sciences2 (2016): 48-51.
12. Lenich A., et al. “First results with the trochanter fixation nail (TFN): a report on 120 cases”. Archives of Orthopaedic and Trauma Surgery10 (2006): 706-712.
13. T Sathish Kumar., et al. “Is trochanteric fixation nail a better implant in the management of intertrochanteric fracture in elderly compared to dynamic hip screw?” International Journal of Orthopaedics Sciences4 (2017): 191-196.
14. Shukla R., et al. “Trochanteric fixation nail in intertrochanteric fractures of femur in adult population”. African Journal of Trauma 6 (2017): 27-31.
15. Liu W., et al. “Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails”. The Journal of Trauma and Acute Care Surgery 75 (2013): 304-310.
16. Goodnough LH., et al. “Trochanteric fixation nail advanced with helical blade and cement augmentation: early experience with a retrospective cohort”. The European Journal of Orthopaedic Surgery and Traumatology (2020).
17. Lenich A., et al. “First clinical and biomechanical results of the Trochanteric Fixation Nail (TFN)”. Technology and Health Care4-5 (2006): 403-409.
18. Angadi DS., et al. “Rigid intramedullary nail fixation of femoral fractures in adolescents: what evidence is available?” Journal of Orthopaedics and Traumatology 15 (2014): 147-153.
19. Daoud Makki., et al. “Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures”. International Journal of the Care of the Injured (2015): 1-5.
20. Stephen A Flores., et al. “The Utility of the Tip–Apex Distance in Predicting Axial Migration and Cutout With the Trochanteric Fixation Nail System Helical Blade”. Journal of Orthopaedic Trauma6 (2016): e207-e211.
21. Richard S Yoon., et al. “Trochanteric entry femoral nails yield better femoral version and lower revision rates—A large cohort multivariate regression analysis”. International Journal of the Care of the Injured (2016): 1-5.
22. Paresh Patil., et al. “A study of unstable intertrochanteric fractures treated with trochanteric fixation nail”. International Journal of Current Research5 (2016): 30742-30748.
23. Michael J Gardner and Dean G Lorich. “Unstable intertrochanteric fractures: lessons learned from a clinical study of the trochanteric femoral nail”. AO Dialogue (2007): 30-31.

Citation

Citation: Prajwal GS., et al. “Surgical Management of Intertrochanteric Fractures in Adults by Trochanteric Fixation Nail (TFN)".Acta Scientific Orthopaedics 4.10 (2021): 03-08.

Copyright

Copyright: © 2021 Prajwal GS., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.