Management of Subtrochanteric Fracture Femur by Proximal Femoral Nail

Background: Subtrochanteric fractures of the femur remain some of the most challenging fractures faced by orthopaedic surgeons. Most of the fractures in the elderly results from trivial fall from standing or while walking, whereas in the younger age group it is mainly due to road traffic accidents. Closed management of these subtrochanteric fractures poses difficulties in obtaining and maintaining reduction, hence making operative management the preferred method of treatment.Rapid strides in new implants, instrumentation and fracture fixation techniques in quest for ideal implant for fixation of these fractures have made many options available. This study was conducted to evaluate the outcome of management of 60 adult patients with subtrochanteric femoral fractures using proximal femoral nail(PFN). Materials and Method: This prospective study included 60 patients with subtrochanteric fracture admitted to Guru Gobind Singh Medical College, Faridkot who underwent intramedullary fixation with PFN from May 2012 to August 2014.Only fresh subtrochanteric fractures within one week of injury were included in the study. Pathologic fractures, multiple fractures, fractures in children, old neglected fractures were excluded from the study. Results: In our study of 60 patients, there were 45 male and 15 female patients with mean age of 36 years( range from 1768 years).Sixty seven percent of the patients admitted were road traffic accidents, 23% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 7 days and mean time of full weight bearing was 14 weeks in our patients. Out of 60 patients, 3 patients were lost to follow up and 1 case died due to associated medical co-morbidity. Good to excellent results were seen in 80% of cases in our study. Conclusion: PFN is a viable treatment option for subtrochanteric fractures with high rate of fracture union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.