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.