Outcomes of Proximal Femoral Nail in Subtrochanteric Femur Fractures”- A Case Series

Background: Subtrochanteric fractures are defined as those occurring below the lesser trochanter and extend distally up to 5 cm in the shaft of the femur: Subtrochanteric fractures of the femur remain some of the most challenging fractures facing Orthopaedic surgeons. Internal fixation of these fractures has gained widespread acceptance but the problems i.e. malunion, nonunion, implant failure, refracture and infection encountered after surgical treatment of these fractures have prompted continued development of new devices and treatment programs. We study the outcome of these fractures treated with long proximal femoral nail.

Aims: Here we present a study evaluating the results of subtrochanteric femur fractures treated with proximal femur nail.

Study Design: This is a prospective observational type of study.

Place and Duration of Study: The present study consist of the patients admitted in orthopaedics unit of VS General hospital Ahmedabad from June 2013 till August 2017.

Methodology: All patients above 16 years of age who presented to our emergency department with subtrochanteric fracture of the femur were included in the study. Radiographs were taken and all the fractures were classified according to the Seinsheimers classification. All patients underwent fixation with the proximal femoral nail. The functional outcomes of the patients were assessed using the Harris hip score.

Results: Most commonly seen fractures pattern in this study is Seinschemer‘s type III A. In our study 74.28% (26) patients did not require any support for walking and 5(14.28%) patients required canes for long walks and only one patient was mobilising with the help of crutch. Squatting was possible in 15(42.85%) patients with ease and with difficulty in 06 (17.14%) patients. 14 patients were unable to squat. In this study sitting cross legged with ease is possible in 18 (51.42%) patients. 10(28.57%) patients were able to sit cross legged but with difficulty.07 (17.14%) patients were unable to sit cross legged.

Conclusion: Proximal Femoral Nail is a good implant for the treatment of unstable subtrochanteric fractures of femur. In our study we had good results with the proximal femoral nail, it requires minimal exposure and achieves biological fixation. It allows early weight bearing which is beneficial and has fewer implant related complications. Proximal femoral nail is thus a choice of implant for fixation of subtrochanteric fractures.