Subtrochanteric fractures of the femur

Parker, Martyn J.; Dutta, Bornali; Sivaji, C.; Pryor, G. A.

doi:10.1016/s0020-1383(96)00171-4

Cited by 63 publications

(30 citation statements)

References 22 publications

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“…Parker et al [6] reviewed the epidermiology of subtrochanteric fractures and showed that the average age of the patients was 74 years. Average age of the patients in this study is 54 years.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Va¹,

Mohammed²

2017

Int. J. Orthop. Sci.

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Background: Subtrochanteric fractures are often difficult to treat and may well be associated with a mortality of more than 20%. The subtrochanteric region is the site of very high mechanical stresses, the medial and posteromedial cortices were subject to high compressive forces whereas the lateral cortex experiences high tensile forces. Operative management is the treatment of choice to achieve the goals of early rehabilitation and optimal functional recovery. The purpose of the present study is to evaluate functional outcome of the subtrochanteric fractures -both high energy and low energy -treated by PFN. Functional as well as anatomical results were evaluated with regard to pain, limping, activities, deformity and range of movements. The present study was done with the hope to find out a solution for the treatment of unstable comminuted subtrochanteric fractures. Materials and Methods: A total of 24 patients with subtrochanteric fractures presenting in the Department of Orthopaedics from August 2015 to August 2016 were treated by closed intramedullary nailing using PFN and the peroperative and postoperative complications and the functional outcome were studied. All the data was arranged in a tabulate form and analyzed using SPSS software. Chi square test was applied as a test of significance. Probability value of less than 0.05 was considered significant. Result: Out of the 24 patients 16 (66.66%) were males and 8 (33.34%) were females. Most of the cases came under. Type IB (62.50%) and Type IA (20.84%). There were 8.3% cases each of Type II A and Type II B. In this study, 14 cases (58.34%) were locked proximally and distally with 2 screws each. In 4 cases (16.66%), 2 proximal screws and 1 distal screw, in 2 cases of intertrochanteric fracture, only 2 proximal screws were used. Average duration taken for union in this study was 4.5 months (Ranges from 3 months to 7.5 months). 22 (90%) united by 6 months. There were no cases of infection. No shortening in 10 cases. Less than 1 cm shortening in 9 cases and 3.2 cm shortening in one case was found. Proximal screw penetration was noted in one case (RT type II A) at the time of 3 months follow up. Conclusion: PFN is a safe, effective and patient friendly device useful for the treatment of all subtrochanteric fractures irrespective of their comminution. Early mobilization and rehabilitation is possible since it is a closed intramedullary procedure.

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Section: Discussionmentioning

confidence: 99%

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Va¹,

Mohammed²

2017

Int. J. Orthop. Sci.

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“…Subtrochanteric fracture of the femur is a variant of peritrochanteric fracture of the femur [1] . The incidence is relatively much lower (3.9% of all the proximal femoral fractures) [2,3,5] . It lies in the area which is 5cm below the lesser trochanter.…”

Section: Introductionmentioning

confidence: 99%

Operative results of proximal femoral nailing in subtrochanteric fracture femur using pyriformis fossa entry

Khan¹,

Lil²

2018

Int. J. Orthop. Sci.

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Introduction: Subtrochanteric fracture of the femur is a variant of the peritrochanteric fracture of the femur. It extends upto 5 cm below the lesser trochanter. The incidence is relatively much lower (3.9% of all the proximal femoral fractures). It is common in the older population with low energy trauma along with osteoporosis and in younger patients with high energy trauma [4] . Studies have shown that the subtrochanteric region is the most stressed area which concentrates stress on the implant and this is difficult to treat due to complications. With the improved knowledge and understanding of the fracture pattern, specific treatment options with successful results `1may be obtained. Materials and methods:A total of 36 cases of subtrochanteric femur fracture patients were selected in our study and we did proximal femur nailing in all patients, where entry of nail was taken through pyriformis fossa. Among them, 22 fractures were successfully reduced with traction on a fracture table, but circlage wiring through a small incision was needed in 6 cases. The classification of fracture was based on Russell and Taylor classification. Blood loss, duration of surgery, functional outcomes were recorded. All patients' assessment of movement at hip was assessed by Harris hip score. Clinical and radiographic analyses were done at 3 weeks, 6 weeks, 3 months, 6 months and 1 year. Results: Out of 36, 25 were males and 11were females. One patient had rotational malallignment of 12 degrees. There were no other malallignment or iatrogenic fracture comminution. The average operative time was 48 minutes. All fractures united eventually with no bone grafting needed in any patient. The functional hip outcome in terms of scoring by Harris hip score showed excellent results on follow ups. Conclusions: A femoral nail with ante grade entry through the pyriformis fossa showed excellent results in terms of union and functional outcome of patients.

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“…Closed nailing constitues a form of biological fixation of the femur which may be credited for a shorter time to union. The two primary options for treatment of subtrochanteric fractures are intramedullary fixation and extra medullary fixation 5 .Many internal fixation devices have been recommended, but because of high incidence of complications like non-union and implant failure, a series of evolution in designing a perfect implant has begun. Only recently better understanding of biology, reduction techniques and biomechanically improved implants like Gamma nail, Russell Taylor nail, Proximal femoral nail allowed for these fractures to be addressed with consistent success.…”

Section: Introductionmentioning

confidence: 99%

Management of Subtrochanteric Fracture Femur by Proximal Femoral Nail

2015

IJSR

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17-68 years).Sixty seven percent of the patients admitted were road traffic accidents, 23% due to fall from height and 10% due to trivial fall with right side being more common side affected. Russell and Taylor type IA fracture accounted for 40% of cases. Mean duration of hospital stay was 7 days and mean time of full weight bearing was 14 weeks in our patients. Out of 60 patients, 3 patients were lost to follow up and 1 case died due to associated medical co-morbidity. Good to excellent results were seen in 80% of cases in our study. Conclusion: PFN is a viable treatment option for subtrochanteric fractures with high rate of fracture union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.

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Subtrochanteric fractures of the femur

Cited by 63 publications

References 22 publications

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Functional outcome of comminuted unstable subtrochanteric fractures treated by proximal femoral nail [PFN]

Operative results of proximal femoral nailing in subtrochanteric fracture femur using pyriformis fossa entry

Management of Subtrochanteric Fracture Femur by Proximal Femoral Nail

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