Study Of Ender’s Nailing In Subtrochanteric Fracture Of Femur In Adults.

Abstracts: Background: Fractures of the subtrochanteric area of the femur represents a difficult therapeutic problem for the orthopaedic surgeon. Comminution, high stress concentration and osteoporosis in this region can lead to failure of fixation, shortening and nonunion. Favourable mechanical conditions are obtained following flexible intramedullary nailing like Ender’s nailing,because axial forces are distributed along the entire length of the nail and bending moments are minimized. Compression of the fracture fragments occur without excessive stress on the nails, enabling the patient to bear weight on the extremity. Methodology: This is a study of 34 cases of subtrochanteric fractures of femur in adults treated by Ender’s nailing at our place. Age ranging from 19 to 70yrs..In our study patient’s distribution according to frank-seinsheimer classification was as follows : Type I: nil, II-a: 1 pt., II-b: 5 pts., II-c: nil, III-a: 10 pts., III-b: 5 pts., IV: 5 pts., V: 8 pts. All the patients were having close fracture. We used 4.5 Enders nails in all patients. In 24 pts.total 3 nails and in 10 pts.total 4 nails were used. In 5 patients open reduction and encirclage wiring was done. In all other patients close reduction was done. Results: Average union time was 15 weeks. No pt. got postope. infection. Excellent and good results were found in 27 pts.out of 34 pts. Conclusion: Average duration of surgery was 1 hour and 10 minutes. Per-operative average blood loss was only 75cc. Post- operatively 23 patients out of 34 patents started partial weight bearing walking from 1stpost operative day. Union rate was 97%, no malunion in coxavara, 6% patient got external rotation deformity.

Disengagement of the Lag Screw from Side plate in a Subtrochanteric Fracture of the Femur treated with Compression Hip Screw: A Case Report

Subtrochanteric fractures of the femur can be treated by sliding hip screw devices. We encountered a subtrochanteric fracture in a 43 years old male. Open reduction and fixation with a sliding hip screw and plate were performed. One week later, the sliding screw disengaged from the side plate. In the operating room, the side plate was changed to the long barrel type and a compression screw was inserted. At two year follow-up, the fracture was united with good function.