Proximal Femoral Nailing in Trochanteric Fractures

Trochanteric fractures, one of the commonest fractures treated by an orthopedic surgeon, typically occur in an elderly population with osteoporotic bones, mostly as a result of low velocity injury. The main stay of treatment for these fractures is fixation with screw–side plate device or intramedullary device. Recently, intra-medullary device is gaining popularity due to their distinct biomechanical advantages and ease of application. This prospective study was conducted in the epartment of Orthopaedic Surgery, Kathmandu Medical College Teaching Hospital. A total of 110 patients with trochanteric fractures attended our hospital from August 2008 till July 2013, and 45 patients were treated using proximal femoral nail (PFN). These patients were evaluated in terms of per-operative blood loss, duration of surgery, need of post-operative analgesia, immediate post-operative rehabilitation and final functional outcome at one year follow-up. Out of 45 patients treated with PFN, 38 were included in this study. Amongst the 7 excluded patients, two were lost on follow-up, four had other associated fractures and one died because of cardiac co-morbidity. The patients were evaluated at 1 week, 3 weeks, 6 weeks, 3 months, 6 months and 1 year postoperative period. The evaluation was primarily done by taking radiographs and functional outcome scores using Harris Hip Scoring system. There were 17 males and 21 females (M: F: 0.80:1) with the mean age of 70.67 years (range: 50 to 98 years). The mean per-operative blood loss was 65.83 ml (range: 30 to 120 ml) and the mean duration of surgery was 42.20 min (range: 23 to 90 min). In all cases parenteral analgesia was required on the first postoperative day only, following which oral analgesics was advised as required. Sixty percent of the cases were ambulatory from the first post-operative day and the rest were ambulatory from the second postoperative day. All but one fracture united within 3 months and non of them required any form of assistance in their daily activities. One patient had delayed union and was administered 2 doses of platelet-rich-plasma, at two weeks interval, following which signs of union were evident by the end of 9 months. PFN, once thought as an implant for unstable trochanteric fractures only, can be a good option for all grade inter-trochanteric fractures. PFN helps in better restoration of preoperative walking ability and early return to function.