The role of entry point and correct reduction in post-operative outcome of intertrochanteric femur fractures treated by short and long proximal femoral nails

Introduction: This study was performed in the department of orthopaedics, VIMSAR, Burla between July 2015 and June 2017 for evaluation of outcome of the surgical treatment of patients with intertrochanteric fracture treated with short and long proximal femoral nail and determine the role of entry point, fracture reduction in relation to neck shaft angle in treatment outcome in these patients. Materials and Methods: All the patients with intertrochanteric fractures treated by short and long proximal femoral nails were retrospectively analysed. Out of 260 patients, 160 patients matched our inclusion criteria. Among these 160 patients, the number of patients treated by short proximal femoral nails was 100 and those treated with long proximal femoral nails was 60. Comparative evaluation of relevant patient variables, operation related variables, Post-operative outcome in terms of radiological and functional evaluation and fracture reduction in relation to neck shaft angle were carried out. Results: We have got some unique results. Taking into consideration of parameters like AO classification, injury to surgery interval, Post-operative hospital stay, Mean time to fracture union, post-operative complications including re-fractures, postoperative outcomes in terms of rehabilitation and gaining full function, there was no significant difference between short and long PFN groups. But time taken for surgery, intraoperative blood loss and requirement for transfusion were greater in treatment with long proximal femoral nail. In comparison, Short proximal femoral nail group showed more post-operative pain and increased need for walking aids. Patients in whom quality of bone was good, correct entry point during nail insertion was made and neck shaft angle was maintained during pre-operative and intra operative period, treatment outcome was excellent irrespective of the length of the nail. Conclusion: The long and short proximal femoral nails both are equally effective in treatment of intertrochanteric femur fractures but choice of nail should be based on skill, expertise and experience of the surgeon. Most importantly the quality of bone, operative reduction in relation to neck shaft angle and correct entry point in both long and short proximal femoral nail guide the treatment outcome maximally irrespective of the nail length.