Study of clinical and functional outcomes of unstable intertrochanteric femur fractures treated with long proximal femoral nail

Introduction: The following study was conducted to examine the long term clinical, radiological and functional results of unstable intertrochanteric femur fractures treated with long Proximal Femoral Nail. Materials and Methods: This was a prospective, non-randomized study of 50 cases of intertrochanteric fractures of unstable variety treated by long Proximal Femoral Nail at the Department of Orthopedics, B J Medical College and Civil Hospital, Ahmedabad, between 2014 to 2016. Patients were undergoing primary surgery, with unstable types of fracture pattern AO/OTA type 31A2.2 to 31A3.3. Pathological fractures and patients with previous surgery on proximal femur were excluded. Results: The sample consisted fifty patients, 33 were males and 17 females. The patients’ ages ranged from 18 - 90 years with mean of 68.2 years. Majority (86%) of the intertrochanteric fractures occurred following trivial trauma usually a domestic accident like fall in bathroom or fall from stairs. Associated bony injuries were present in 3 cases (6%). Most common associated injury was fracture lower end radius (in all 3 cases). 29(58%) patients had an osteoporosis Grade 5 while 17 (34%) had Grade 4. AO/OTA Type A2.3 type of fractures were most common in 31 (62%) patients, followed by A2.2, A3.1 and A3.3. Functional Outcome was assessed with modified Harris Hip Score in which 70% of the patients had good to excellent functional results on final follow up at 1 year. Conclusion: The proximal femoral nail, is an optimum implant for the internal fixation of unstable intertrochanteric fractures with advantages of stable fixation, perfect reduction, early weight bearing and ambulation, shortened hospital stay and improved rate of union with early resumption of independent life style.