A Study of Management of Subtrochanteric Fracture Femur by Proximal Femoral Nailing

Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN).We report here the results of a prospective study carried out at our institute on 60 consecutive patients who had suffered high subtrochanteric fracture between May 2011 and October 2014 and were subsequently treated with a PFN.Close to anatomical reduction of the fracture fragments was achieved in 54 patients, while limited open reduction was required in 3 patients.In the present series, 3.33(2) of cases had superficial infection and no deep infections were recorded.Cut of the antirotational screw was noted in 1 patient.Fracture of the shaft with breakage of the nail was noted 1.66% (1) of patients.In the current series, the mean Harris Hip score was 80.76 and it was ranging from 100-29.In this series all the patients between 20-30 years had excellent result irrespective of the type of fracture.Older age group patients had relatively poor results and 50% (5) of them had poor results and another 50% (5) had good to fair results.In this study excellent outcome was not seen in the older age group patients.Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications.Osteosynthesis with the PFN offers the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.