Chandrasekhar S, Manikumar C. J
BACKGROUND Intertrochanteric femoral fractures are of intense interest globally. They are the most frequently operated fractures and they have the highest postoperative fatality rate of surgically-treated fractures and have become a serious health issue. The incidence of fractures in proximal femoral area has risen with increasing numbers of elderly persons with osteoporosis and traffic accidents in young adults. In elderly patients due to their poor bone quality, it is very difficult to achieve and maintain stable fixation. The aim of surgery is to achieve early mobilisation and prompt return to pre-fracture activity level. The treatment of these fractures remains a challenge to the surgeon. MATERIALS AND METHODS The study was conducted on 20 cases of intertrochanteric fractures admitted in King George Hospital, Visakhapatnam, in the Department of Orthopaedics during November 2015 to November 2017. All cases reported to hospital were subjected to scrupulous preoperative evaluation. Those fulfilling inclusion criteria were operated upon. All the fractures were treated with proximal femoral nail. All the patients were evaluated on follow ups at the intervals of 6 weeks and 6 months according to modified Harris hip score. RESULTS The age distribution was from 20 to 70 years. The mean age was 58.6 years. Most of the patients with domestic fall were older in age or had osteoporosis. 65% of fractures were right sided and 35% were left sided. Fractures were classified as per Orthopaedic Trauma Association (OTA) classification in which 31 A1 were considered stable fractures and 31 A2 and 31 A3 were unstable fractures. The present study constituted 80% unstable fractures. There were 2 (10%) cases of infection seen in the study. We report no nonunion and no Z-effect with the present study. CONCLUSION We conclude from our study that proximal femoral nailing can be considered the most rational method of treating intertrochanteric fractures, especially the unstable and reverse oblique type fractures in elderly. PFN insertion is a minimally-invasive procedure with less operating time and less blood loss. This closed technique preserves the fracture haematoma leading to early union and early mobilisation. It can be used with equally good results in all grades of osteoporosis with minimal postoperative complications. Early mobilisation and weightbearing with rapid rates of healing was possible. But, proximal femoral nailing requires a higher surgical skill, good fracture table and image intensifier. It has a steep learning curve.
