Aim: To study clinicoradiological outcome of subtrochanteric femur fractures following intramedullary nailing.
Materials and methods: This was a prospective study of 22 cases of subtrochanteric fractures admitted and operated by intramedullary nailing at Southern Railway HQ Hospital, Chennai, between June 1, 2017, and May 31, 2018.
Results: The mean age distribution was 65.09 ± 17.84 years with 12 females and 10 males. According to Seinsheimer classification, there were six cases of type II, seven cases of type III, three cases of type IV, and six cases of type V. Intraoperative reduction techniques included closed reduction in 25% of subjects, limited open reduction in 50% and open reduction, augmentation with cerclage wiring in remaining 25%. Radiographic examination using radiological union score of hip (RUSH) was done to evaluate fracture union at monthly follow-up. Our mean time for union was 13.86 ± 3.8 weeks. Functional recovery was evaluated by the Harris hip scoring (HHS) system at 1, 3, 6, and 12 months postoperatively. The mean HHS at 6 months and 12 months were 81.57 ± 12.39 and 87.33 ± 8.2, respectively. Excellent to good functional outcome was seen in 76% of cases. There were two patients with superficial infections, one case of foot drop, and another case of lag screw cut-out. The mean shortening noted at final follow-up was 1.548 ± 0.57 cm.
Conclusion: An intramedullary nail is an efficient device for the treatment of subtrochanteric fractures with high rate of bony union provided optimal reduction of the fracture and good positioning of the nail and screws is achieved.
Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am 1978;60(3):300–306. DOI: 10.2106/00004623-197860030-00004.
Puhaindran ME, Farooki A, Steensma MR, et al. Atypical subtrochanteric femoral fractures in patients with skeletal malignant involvement treated with intravenous bisphosphonates. J Bone Joint Surg Am 2011;93(13):1235–1242. DOI: 10.2106/JBJS.J.01199.
Fairbanks C, Davis J, Sanchez H. Epidemiology of Hip Fractures, a Retrospective Review, in Research Appreciation Day [Internet]. 2016. Available from: https://digitalcommons.hsc.unt.edu/rad/RAD16/CommunityMedicine/2.
Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am 2004;35(4):473–483. DOI: 10.1016/j.ocl.2004.05.006.
Ehmke LW, Fitzpatrick DC, Krieg JC, et al. Lag screws for hip fracture fixation: evaluation of migration resistance under simulated walking. J Orthop Res 2005;23(6):1329–1335. DOI: 10.1016/j.orthres.2005.05.002.1100230614.
Kokoroghiannis C, Aktselis I, Deligeorgis A, et al. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures—a review. Injury 2012;43(6):686–693. DOI: 10.1016/j.injury.2011.05.031.
Banan H, Al-Sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)—our first 60 cases. Injury 2002;33(5):401–405. DOI: 10.1016/S0020-1383(02)00054-2.
Tyllianakis M, Panagopoulos A, Papadopoulos A, et al. Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): long term results in 45 patients. Acta Orthop Belg 2004;70(5):444–454.
Saarenpää I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients. Int Orthop 2009;33(1):255–260. DOI: 10.1007/s00264-007-0458-y.
Kim K, Won Y, Smith DH, et al. Clinical results of complex subtrochanteric femoral fractures with long cephalomedullary hip nail. Hip Pelvis 2017;29(2):113–119. DOI: 10.5371/hp.2017.29.2.113.
Kumar N, Kataria H, Yadav C, et al. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results. J Clin Orthop Trauma 2014;5(3):137–145. DOI: 10.1016/j.jcot.2014.07.009.
Zha G-C, Chen Z-L, Qi X-B, et al. Treatment of pertrochanteric fractures with a proximal femur locking compression plate. Injury 2011;42(11):1294–1299. DOI: 10.1016/j.injury.2011.01.030.
Ballane G, Cauley JA, Luckey MM, et al. Secular trends in hip fractures worldwide: opposing trends east versus west. J Bone Miner Res 2014;29(8):1745–1755. DOI: 10.1002/jbmr.2218.
Ahmad S, Singh R, Ghani A, et al. Management of subtrochanteric fractures with long PFN: union rates and functional results. Int J Curr Res Rev 2017;9(9):14–19.
Kumar HVM, Krishna Murthy T, Ankith NV, et al. A prospective study of clinicoradiological outcome assessment in proximal femoral fractures treated with proximal femoral nail. Int J Contemp Med Res 2016;3(5):1343–1346.
Borens O, Wettstein M, Kombot C, et al. Long gamma nail in the treatment of subtrochanteric fractures. Arch Orthop Trauma Surg 2004;124(7):443–447. DOI: 10.1007/s00402-004-0711-4.
Lobo-Escolar A, Joven E, Iglesias D, et al. Predictive factors for cutting-out in femoral intramedullary nailing. Injury 2010;41(12):1312–1316. DOI: 10.1016/j.injury.2010.08.009.