Title: Outcome of Subtrochanteric Fractures of Femur Managed by Internal Fixation using long Proximal Femoral Nail: A Prospective Study
Authors: Amit Thakur, Zubair A. Lone, Tahir Afzal, John Mohd, Amarjeet Singh
DOI: https://dx.doi.org/10.18535/jmscr/v8i2.52
Abstract
Introduction
Fractures of the proximal femur that occur from lesser trochanter to the isthmus of the femoral canal, which is roughly 5 cm distal to the lesser trochanter, are generally termed as subtrochanteric fractures.1 Previously these fractures were grouped along with complex intertrochanteric fractures.2 However, subtrochanteric fractures present with multitude of management and rehabilitation problems. This has prompted the Orthopaedic trauma surgeons to provide special consideration to these fractures. Subtrochanteric fractures tend to have a bimodal age distribution.3 Young patients presenting with subtrochanteric femur fractures tend have high energy trauma as the mode of injury, where as in elderly patients these fractures, most of the times, are osteoporotic.4
The subtrochanteric fractures of femur have been classified by various authors, but most of the classifications systems do not have a bearing on the management and outcome. Seinsheimer classification (Figure 1) is one of the most practical classification systems available for subtrochanteric fractures.5 Russel and Taylor classification (Figure 2) is the other commonly used classification for subtrochanteric fractures.
The surgical management of the subtrochanteric fractures is the accepted gold standard.6 Two broad categories of the implants for the internal fixation of the subtrochanteric fractures are available, which include extramedullary side plate devices and intramedullary fixation devices. The extramedullary side plate devises include dynamic condylar screw (DCS) and condylar blade plate while as the intramedullary implants include the proximal femoral nail (PFN).
In our study, we studied the functional outcome and complication profile of the long proximal femoral nail for the internal fixation of the subtrochanteric femoral fractures.
References
- Fielding JW. Subtrochanteric fractures. Clin Orthop Relat Res 1973;92:86-99.
- Moore JR. Fractures of the upper end of the femur including fracture dislocations at the hip joint. Am J Surgery 1939;44:117-134.
- Velasco RU, Comfort TH. Analysis of treatment problems in subtrochanteric fractures of the femur. J Trauma 1978; 18:513-523.
- Russell TA, Taylor JC. Subtrochanteric fractures of the femur. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal Trauma Vol-2, Philadelphia: WB Saunders and Company; 1992.pp 1495-1524.
- Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surgery 1978;60A:300-308.
- SH Sims. Subtrochanteric femoral fractures. Orthop Clin North Am 2002;33 (1):113-126.
- Radford PJ, Howell CJ. The AO dynamic condylar screw for fractures of femur. Injury 1992;23(2):89-93.
- Nungu KS, Olerud C, Rehnberg L. Treatment of subtrochanteric fractures with AO dynamic condylar screw. Injury 1993;24:90-92.
- Emrah KS, Ahmet IM, Hakan K, Levent K, Umut C, Ahmet S. Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol 2014;24(3):347–352.
- RKJ Simmermacher, AM Bosh, CV Werken. The AO/ASIF-proximal femoral nail: a new device for the treatment of unstable proximal femoral fractures. Injury 1999;30(5):327-332.