G. Praneeth Kumar Reddy1 , Kasarapu Nagaravi Prasad2
BACKGROUND Growing population and increase in number of road traffic accidents have resulted in an enormous increase in the number of hip fractures. In younger patients, fractures usually result from high energy trauma like RTA and fall from height and accounts for only ten percent.1 Older patients suffering from a minor fall can sustain fracture in this area because of weakened bone due to osteoporosis or pathological fracture and this accounts for 90%. The incidence of proximal femoral fractures among females is 2 to 3 times higher than the incidence of such fractures among males.2 Also, the risk of sustaining a proximal femoral fracture doubles every 10 years after the age of 50 years.3 METHODS The present study was carried out in Viswabharathi Medical College & General Hospital, Kurnool, from January 2018 to December 2019. 50 patients with subtrochanteric fractures who came to casualty and outpatient department were admitted and treated surgically with Dynamic Condylar Screw (DCS) fixation. RESULTS In our series maximum age was 65 years and minimum age was 24 years. 28 cases (56%) were in the age group 24 to 40 years and other 18 cases (36%) were above 50 years of age and the mean age was 45 years. AO classification was taken into account for subtrochanteric fractures, in this study. There were 28 cases (56%) of type A fractures, 14 cases (28%) of type B fractures and 8 cases (16%) of type C fractures. 40 patients came to hospital within 24 hours and 10 patients reported within 24-72 hours. Average time interval between injury and surgery was 5 days. Primary bone grafting was done in 8 patients (16%), in whom there was posteromedial comminution. Source of bone grafting was iliac crest. Blood loss was measured by mop count (each fully soaked mop containing 50 ml blood). The average duration of surgery was 90 minutes and average duration of x-ray exposure was 80 seconds. In the immediate post-operative period, we had no complications. CONCLUSIONS Operative fixation is treatment of choice for subtrochanteric fractures of femur in adults. Successful surgical outcome is dependent not only on implant selection but also heavily influenced by surgical skill and experience. In the present study, we observed that Dynamic Condylar Screw fixation (DCS) for subtrochanteric fractures is safe, effective and successful procedure, provided the principle of accurate reduction, minimal soft tissue stripping, and stable internal fixation are followed.
