ABSTRACT
Introduction: Present study was conducted to study the modes of injury in Subtrochanteric fractures of femur and to know the outcome of Proximal Femoral Nail in the treatment of Subtrochanteric fractures of femur. Material & Methods: A prospective observational study was conducted on a total of 30 cases of subtrochanteric fractures of femur. All patients were radiographed at an interval of 6 weeks after nailing, till evidence of union. The patient followed up for one year after the surgery at regular interval. Clinically, union of fracture was assessed and also examination for shortening and deformity was done. Functional outcome was assessed based on Modified Harris Hip Score. Results: Out of 30 cases, 24 cases gave history of road traffic accidents and 6 cases gave history of slip and fall. Full range of flexion of hip at 12 weeks post–operative was observed in 80% of cases and about 20% of patients showed minimally limited flexion. On a whole, all the patients had a satisfactory range of movements post operatively. Our study showed 80% of patients showed full range of movements and 20% showed minimally limited movements at 12 weeks post–operative. On a whole the range of knee movements was satisfactory. Conclusion: Proximal Femoral Nail is a relatively easy procedure and a biomechanically stable construct allows early weight beå. It offers the advantages of high rotational stability of the head–neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. Thus, the Proximal Femoral Nail is a suitable implant for treatment of all Subtrochanteric fractures
ABSTRACT
[Objective]To explore the technique and results of reverse less invasive stabilization system(LISS) plating for subtrochanteric femur fractures.[Method]From October 2007 to May 2009,31 cases of fresh subtrochanteric femur fractures were treated with reverse LISS. There were 23 males and 8 females,with an average age of 48.6 years (range 27 to 83 years). Twelve injuries were the result of a traffic accident,six,a fall from a greater height,four,a crush injury and nine,a fall from a standing height. According to Seinsheimer classification,four fractures were type ⅡC,twelve ⅢA,six ⅢB,six Ⅳ and three Ⅴ. After anesthesia was effectively administered,subtrochanteric fracture was reduced indirectly with patient on a fracture table. Then,the reverse LISS plate was inserted through a lateral incision of the greater trochanter between the lateral vastus muscle and the periosteum. Guided by the aiming arm,4 to 5 screws were inserted through stab incisions into the proximal and distal fragments,respectively. [Result]Operative time averaged 50 minutes (range,35-80 minutes) and estimated blood loss averaged 90 ml(range,60-150 ml). Thirty-one patients were available for evaluation with an average follow-up of 15.6 months. All fractures healed at a mean of 18.2 weeks (range 13 to 32 weeks). There was no failed fixation,or deep infection. Average range of motion of the hip joint was recorded as follows:flexion 115?,external rotation 35?,internal rotation 15?,adduction 15?,and abduction 36?. According to the modified Harris hip score,scores ranged from 82 to 100 (average,92.6),and there were 24 excellent and 7 good results.[Conclusion]Reverse LISS plating yields good results in subtrochanteric femur fractures,with stable fixation and minimal invasive procedure.