Indian Journal of Orthopaedics Surgery


Long proximal femoral nail versus short proximal femoral nail in treatment of unstable intertrochanteric fractures- a prospective randomized comparative study


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Author Details: Mahesh Kumar NB, Ullas Mahesh, Santosh Kumar

Volume : 3

Issue : 1

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 46

Article End Page : 53


Abstract

Background & objectives: In elderly, the Intertrochanteric fractures are one of the most common fractures of the hip out of which more than 50% are unstable. Internal fixation is optimal for it fractures which are very challenging. Evolution of intramedullary devices is a result of dissatisfaction with the extra medullary devices in it unstable fractures our main aim was to compare the effectiveness & drawbacks of short Pfn vs long Pfn in the management of It fractures.
Materials and methods: This study was randomised, time bound, hospital based study conducted in a tertiary hospital, between Sept 2013- Sept 2015. The study included 40cases of unstable it fractures of Group A were operated with short PFN which fitted into the inclusion criteria & group B patients were operated with long Pfn, intraoperative parameters post-operative data & events were noted. Radiological assessment for progression & time of union, fracture alignment & implant related complications were analysed. All patients were accessed in immediate post op, 12 days, 1 month, 3months, 6months & at 1 year with Harris hip score. After data collection, data entry was done in excel worksheet. Data analysis was done with help of SPSS software version 23.
Result: In our study the most common case of IT fracture was a trauma following a fall seen in 57 cases of the 80 cases studied accounting for 71% of the cause of injury, the mean intraoperative blood loss in the long Pfn group was 344.5 ml & the short PFN group was 133.5 ml, P value equals 0.0001 this difference is considered statistically significant. The quality of reduction in the short PFN group was significantly lesser than the long PFN group. The post operative complication in the short PFN group was significantly lesser than the long PFN group. The number of cases with limb shortening were more in the short PFN group than the patients in whom long PFN was used. The mean time of union in the short PFN group was 10.05 weeks and the long PFN group was 21.10 weeks. The two- tailed P value equals 0.0217 by conventional criteria, this difference is considered to be statistically significant. The mean lower extremity functionally scale. In the short PFN group was 63.95 & the long PFN group was 67.50. The two tailed P value equals 0.0114 statistically significant.
Interpretation & conclusion: Short Proximal Femoral Nail provides good fixation for unstable IT fractures, if proper preoperative planning , good reduction & surgical technique are followed , leading to high rate of bone union & soft tissue damage especially for Asian patients with relatively small femora.

Keywords
: Bone nails; Fracture fixation, Intramedullary; Hip fractures; Unstable it fractures; Short PFN, Harry’s hip score