Title: Subtrochanteric Fracture of the Femur in the Elderly Osteoporotic Bone: Long Proximal Femoral Nail is the best Treatment Option: In Rural Population - Case Series
Authors: Neelakrishnan R, Barathiselvan V, Anush Rao P, Akilan C
DOI: https://dx.doi.org/10.18535/jmscr/v6i10.174
Abstract
Sub-trochanteric fractures involve the upper part of femur between the lesser trochanter and the isthmic region. Fractures in this area are complex and treatment is bothersome to both the patient and the orthopaedic surgeon. These fractures are common among elderly adults with coexisting low bone mineral density due to osteoporosis. Plates, dynamic hip screw, dynamic condylar screw, proximal femoral locking compression plate, intramedullary nail, cephalo medullary nail, proximal short and long femoral nail (PLFN) are the transformational procedures available in which the PLFN is being preferred due to stable fixation.1 10 patients were enrolled in the study.2 The patients were assessed using modified Harris hip scoring postoperatively at one, three, six month and one year from the date of surgery. Descriptive statistics was done in the MS office excel 2010. The encountered complications are non union (n=1), postoperative delirium (n=0) and a case of varus deformity (n=1). The biomechanical properties and minimally invasive fixation technique inspite of good of reduction the LPFN takes lower mean duration of surgery, lower rate of reoperation has the least complications among the other fixation techniques.
Background: Long proximal femoral nail has been the standard treatment for subtrochanteric fractures. However there are many fixation implants in the field of traumatology.1 Especially in elderly osteoporotic bone fractures long proximal femoral nail achieved good functional outcome with least complications compared to other implants which leaded to high failure rates.
Methods: A Series of eleven cases of osteoporotic subtrochanteric fractures are operated with long proximal femoral nail. One patient lost follow up. The patients are followed (at one, three, six month and one year) at regular intervals. Results were assessed using modified harris hip scoring system.
Results: Total ten patients were taken for study were followed by minimum six months and maximum of one year. Clinical outcome was rated as per modified harris hip score. Excellent – 60 %, Good – 20 %, Fair – 10%, Poor – 10%.
Conclusion: The surgical management of subtrochanteric fracture with long proximal femoral nail provides stable fixation with moderate pain free early mobilization and good outcome in osteoporotic patients with limited complications.
Keywords: Long proximal femoral nail, osteoporosis, subtrochanteric fracture, modified harris hip scoring system.
