Analysis of Outcome and complication of short intramedullary nail in unstable proximal femoral fracture  seven year retrospective study

Dr. Subhadip Mandal; Dr. H.Bala; Dr. U. Banerjee; Dr. A.S. Mukherjee; Dr. Nitin Kumar; Dr. Srikanta Kundu

Volume : VI, Issue : VI, June - 2017

Analysis of Outcome and complication of short intramedullary nail in unstable proximal femoral fracture seven year retrospective study

Dr. Subhadip Mandal, Dr. H. Bala, Dr. U. Banerjee, Dr. A. S. Mukherjee, Dr. Nitin Kumar, Dr. Srikanta Kundu

Abstract :

Purpose: Multiple studies have demonstrated efficacy of TFN and PFN in unstable trochanteric and sub trochanteric femur fractures respectively. But only a few have discussed on complications with a long term follow – up. Methods: Retrospective study where we analyzed the results of two prospective studies (June 2009 to May 2016). I. Fixation of comminuted unstable trochanteric fracture (AO 2.2 to AO 3.3) with Trochanteric Femoral nail (TFN). (n = 80) and II. Fixation of sub trochanteric femoral fracture (AO 32 A.1 to AO 32 C.3) with Proximal Femoral nail (PFN). (n = 80). Results: All fractures were united. Regarding Cleveland index in 70% (TFN) and 62% (PFN) of cases cephalic screws were in safe zones. Average Tip–apex distances were 12.5 mm (TFN) and 13 mm (PFN). About 36% (TFN) and 40% (PFN) cases showed a fracture gap on immediate post–operative x–ray which disappeared by impaction in next 6–8 weeks. Evaluation of HHS showed 86.25% (TFN) and 91.25% (PFN) cases in excellent to good category at the end of 6 months. Regarding complications, progressive varus collapse was noted in 3.75% cases (TFN). Delayed union was noted in 3.75% (TFN) and 6.75% (PFN) cases. Few cases with migration of screws (Z effect and reverse z effect), fracture shaft of femur and deep wound infection with osteomyelitis of proximal femur required re–operation later on. Conclusion: Fixation by TFN and PFN are an effective treatment in unstable proximal femoral fractures; however meticulous preoperative planning, intraoperative wise decision making and regular follow up are the key to avoid the complications.