Functional Outcomes of Closed Subtrochanteric Fractures Treated by Proximal Femur Nail and Proximal Femur Locking Plate-A Prospective Study

Subtrochanteric fractures are a variant of per trochanteric fractures of femur extending 5cm distal to the lesser trochanter.Management of subtrochanteric fractures is a major challenge and treatment failure is common for it. Aim: To compare the functional outcomes of closed subtrochanteric fractures manged by Proximal femur nail and Proximal femur locking plate.Materials and Methods: This is a prospective study of 20 cases of subtrochanteric fractures admitted in Govt Mohan Kumarmangalam Medical College Hospital, Salem during the period from December 2015 to September 2017.The cases were classified under Russel Taylor classification.Out of the 20 cases 10 cases were managed by Proximal femur nail and 10 cases were managed by Proximal femur locking plate.Results: In our study, we observed that there were significant reduction in operating time(p-value:0.001)and decrease in blood loss (p value:0.000) in cases managed by PFN when compared to PFLCP.Among the cases managed by PFN closed nailing was done in 50% of cases whereas open reduction was required in all cases managed by PFLCP which was a significant difference (p value:0.033).Among the cases managed by PFN, all cases united except for one case which went for a hypertrophic non-union.One of the cases had breakage of the nail distal to the lag screw and one case had breakage of de-rotation screw.Among the cases managed by PFLCP, 3 cases went for non-union with implant failure, for one among these 3 cases revision surgery was done with PFN. Conclusion:Even though both PFN and PFLCP are effective in the treatment of subtrochanteric fractures, we observed that PFN was a better implant than PFLCP, because PFN enables more of a biological fixation with less disturbance of fracture haematoma, faster than PFLCP and lesser amount of blood loss.