Efficacy of proximal femoral nail in peritrochanteric femoral fractures of elderly patients

Authors:Harish Kumar Jain , Suresh Dhakar , Manoj Sharma , Mukul Jain , Hemlata Sharma
Int J Biol Med Res. 2012; 3(3): 1900 - 1903.  |  PDF File

Abstract

Peritrochanteric fractures of the femur most often occur in patients over 60 years of age. They are more common in women than in men, probably as a result of several factors. Women have wider pelvis with a tendency to coxa vera, are less active and develop osteoporosis earlier. Peritrochanteric fractures usually unite well if reduction and fixation are properly done. The aim of this study is to assess the efficacy of PFN in peritrochanteric fractures in patients above 60 years of age. Short operative time with less exposure and early weight bearing has made the PFN, popular within no time. Methods: patients above 60 years of age treated with proximal femoral nail for peritrochanteric femoral fractures, since June 2008 to November 2011 were included in this study, to evaluate the efficacy of proximal femoral nail. All patients were evaluated at regular follow ups clinically (by Kyle’s criteria), as well as radiologically for a period of minimum one year after surgery. Two patients who had unsatisfactory reduction and 2 patients lost to follow up were excluded from this study. Results: Sixty patients of peritrochanteric femoral fractures, treated with proximal femoral nail were followed up for 12 to 30 months (mean 15 months).Mean age was 72 years (range 60 to 100 years). Thirty seven were male & 23 were female patients. Twenty Seven patients of 31 A1 type, 22 patients of 31 A2 type & 11 patients were of 31 A3 type of AO classification. Mean hospital stay time was 5 days (Range 3 to 9 Days). Mean union time was 12. 9 weeks (range 10 to 18 weeks). Superficial infection in 3 cases, Z effect in 2 cases, breakage of screw in 1 case and non union in 2 cases out of 60 cases were noted. On clinical assessment with Kyle’s criteria, excellent results were found in 51.66%, good in 31.33 %, fair in 13.33 % and poor results in 3.33% cases. Conclusions: Proximal femoral nail provides good fixation of peritrochanteric fractures, thereby providing good results. Minimal exposure, short operative time, less blood loss during surgery, more biological and anatomical fixation and early return to preoperative status enhance the efficacy of treatment.