Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 5

Functional Outcomes of Closed Subtrochanteric Fractures Treated by Proximal Femur Nail and Proximal Femur Locking Plate-A Prospective Study

Sanju Sudheeran Thekkedath* and Raam Mohan Selvarajan

Department of Orthopaedics, Organization is Government Mohan Kumaramangalam Medical College Salem, India

*Corresponding Author: Sanju Sudheeran Thekkedath, Department of Orthopaedics, Organization is Government Mohan Kumaramangalam Medical College Salem, India.

Received: March 24, 2023; Published: April 27, 2023

Abstract

Subtrochanteric fractures are a variant of per trochanteric fractures of femur extending 5cm distal to the lesser trochanter. Management of subtrochanteric fractures is a major challenge and treatment failure is common for it.

Aim: To compare the functional outcomes of closed subtrochanteric fractures manged by Proximal femur nail and Proximal femur locking plate.

Materials and Methods: This is a prospective study of 20 cases of subtrochanteric fractures admitted in Govt Mohan Kumarmangalam Medical College Hospital, Salem during the period from December 2015 to September 2017.The cases were classified under Russel Taylor classification. Out of the 20 cases 10 cases were managed by Proximal femur nail and 10 cases were managed by Proximal femur locking plate.

Results: In our study, we observed that there were significant reduction in operating time(p-value:0.001) and decrease in blood loss (p value:0.000) in cases managed by PFN when compared to PFLCP. Among the cases managed by PFN closed nailing was done in 50% of cases whereas open reduction was required in all cases managed by PFLCP which was a significant difference (p value:0.033). Among the cases managed by PFN, all cases united except for one case which went for a hypertrophic non-union. One of the cases had breakage of the nail distal to the lag screw and one case had breakage of de-rotation screw. Among the cases managed by PFLCP, 3 cases went for non-union with implant failure, for one among these 3 cases revision surgery was done with PFN.

Conclusion: Even though both PFN and PFLCP are effective in the treatment of subtrochanteric fractures, we observed that PFN was a better implant than PFLCP, because PFN enables more of a biological fixation with less disturbance of fracture haematoma, faster than PFLCP and lesser amount of blood loss.

Keywords:Subtrochanteric Fractures; Proximal Femur Nail; Proximal Femur Locking Compression Plate

References

  1. Gokul Nath R., et al. “Role of Proximal Femoral Locking Plate in treatment of Subtrochanteric Fractures; Case series”. MedPulse International Journal of Orthopedics1 (2017).
  2. Hu SJ., et al. “TREATMENT OF FEMORAL SUBTROCHANTERIC FRACTURES WITH PROXIMAL LATERAL FEMUR LOCKING PLATES”. Acta Ortopédica Brasileira6 (2012): 329-333.
  3. Gotfried Y. “The lateral trochanteric wall: A key element in the reconstruction of unstable pertrochanteric hip fractures. In: Clinical Orthopaedics and Related Research. Vol 425. Lippincott Williams and Wilkins (2004): 82-86.
  4. Garrison I., et al. “Subtrochanteric femur fractures: current review of management”. EFORT Open Rev2 (2021): 145-151.
  5. Wang J., et al. “Biomechanical evaluation of four methods for internal fixation of comminuted subtrochanteric fractures”. Medicine (United States)19 (2016).
  6. Zhou Z Bin., et al. “Subtrochanteric femur fracture treated by intramedullary fixation. Chinese Journal of Traumatology - English Edition 18.6 (2015): 336-341.
  7. Sadowski C., et al. “COPYRIGHT© 2002 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Treatment of Reverse Oblique and Transverse Intertrochanteric Fractures with Use of an Intramedullary Nail or a 95° Screw-Plate A PROSPECTIVE, RANDOMIZED STUDY (2002).
  8. Lee WT., et al. “Proximal Femoral Locking Compression Plate for Proximal Femoral Fractures”. Journal of Orthopaedic Surgery (Hong Kong)3 (2014): 287-293.
  9. Chalise P., et al. “Outcome of Pertrochantric Fracture of the Femur Treated with Proximal Femoral Locking Compression Plate”. Nepal Medical College Journal 14 (2012): 324-327.
  10. Kumar N., et al. “Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique and mid term follow up results”. Journal of Clinical Orthopaedics and Trauma 3 (2014): 137-145.
  11. Ashraf J., et al. “Management of subtrochanteric fractures of femur: A narrative review”. Journal of Musculoskeletal Surgery and Research2 (2020): 72.
  12. Siva Rama Krishna C., et al. “Proximal femoral nailing in the management of subtrochanteric fractures of femur in adults”. Indian Journal of Orthopaedics Surgery4 (2020): 293-242.
  13. Jiang LS., et al. “Intramedullary Fixation of Subtrochanteric Fractures with Long Proximal Femoral Nail or Long Gamma Nail: Technical Notes and Preliminary Results”. Annals of the Academy of Medicine of Singapore 36 (2007).
  14. Streubel PN., et al. “Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures”. European Journal of Orthopaedic Surgery and Traumatology4 (2016): 385-390.
  15. 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 Orthopaedics3 (2007): 403-408.
  16. Codesido P., et al. “Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction”. Arch Orthop Trauma Surg 8 (2017): 1077-1085. 017-2722-y
  17. Fixation of Subtrochanteric Fracture of the Femur: Our Experience”. Journal of Clinical and Diagnostic Research1 (2012): 76-80.
  18. Glassner PJ and Tejwani NC. “Failure of Proximal Femoral Locking Compression Plate: A Case Series”. Journal of Orthopaedic Trauma2 (2011): 76-83.
  19. Asif N., et al. “Unstable intertrochanteric fracture fixation - Is proximal femoral locked compression plate better than dynamic hip screw”. Journal of Clinical and Diagnostic Research1 (2016): RC09-RC13.
  20. Wirtz C., et al. “High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate”. Injury 6 (2013): 751-756.
  21. Ekström W., et al. “Quality of Life After a Stable Trochanteric Fracture-A Prospective Cohort Study on 148 Patients”. Journal of Orthopaedic Trauma1 (2009): 39-44.

Citation

Citation: Sanju Sudheeran Thekkedath and Raam Mohan Selvarajan. “Functional Outcomes of Closed Subtrochanteric Fractures Treated by Proximal Femur Nail and Proximal Femur Locking Plate-A Prospective Study”.Acta Scientific Orthopaedics 6.5 (2023): 103-112.

Copyright

Copyright: © 2023 Sanju Sudheeran Thekkedath and Raam Mohan Selvarajan. 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.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


Contact US