Our experience of management of sub trochanteric fractures of femur by proximal femoral nail

The sub trochanteric zone of the femur is the area extending up till 5 cm distally from the inferior border of the lesser trochanter or the junction of the proximal third and middle third of the femoral shaft. Fracture patterns presenting major displacement in this area are considered sub trochanteric fractures despite their proximal or distal extension. 1 High biomechanical stress concentration along with lower vascularity, leads to high rates of nonunion and implant failure, seen in this anatomical region. 2,3 Sub trochanteric fractures account for 7 to 44% of all proximal femoral fractures. 1,4,5 The inherent instability of these fractures and the enormous muscle forces acting across the fracture fragments, render most treatment options difficult. 6 A medial buttress is important to minimise the implant stress and the fatigue failure; 7-9 but when comminution is severe, as is often the case, this cannot be achieved. Options for surgical stabilization of sub trochanteric fractures include dynamic hip screw, gamma nail, Proximal Femoral Nail (PFN) and proximal femoral plate. Intramedullary devices, such as the proximal femoral nail, are biomechanically stronger, more rigid compared to extra medullary devices such as dynamic hip screws, 10 offer theoretical advantages of high rotational stability of the ABSTRACT