Functional outcomes of subtrochanteric fractures of femur managed via long proximal femoral nail (PFN)

Abstract

Background and Objectives: One of the most difficult fractures orthopedic surgeons treat are subtrochanteric femur fractures. In the younger age group, fractures are primarily caused by automobile accidents, but the majority of fractures in the elderly are caused by insignificant falls while standing or walking. Operative management is the best course of treatment for these subtrochanteric fractures since closed management makes it harder to achieve and sustain a reduction. Therefore, the purpose of this study was to ascertain the difficulties associated with the care of subtrochanteric fractures as well as the efficacy of intramedullary fixation of subtrochanteric fractures using a long proximal femoral nail.

Methodology: A long proximal femoral nail was used to treat 25 cases of subtrochanteric fractures that were admitted to ORTHOPEDIC department Gujranwala medical college (Jan 2023 to Dec 2023) This study is prospective in nature. Cases were accepted based on inclusion and exclusion criteria, such as an adult's fresh subtrochanteric fracture. The study excluded patients with pathologic fractures, multiple fractures, pediatric fractures, and elderly neglected fractures.
Results: Of the 25 cases in our study, 16 were male and 9 were female. The patients' ages ranged from 17 to 75 years, with the majority being in the 21–40 year age range. Road traffic accidents accounted for 67% of the cases admitted, followed by falls from a height of 23% and trivial falls from 10%, with the right side being more frequently affected. In 40% of instances, the fracture was a Seinsheimer Type IIIA fracture. Our patients' mean length of stay in the hospital was 12 days, and their mean duration of full weight bearing was 14 weeks.
25 instances in all. In our study, good to outstanding outcomes were observed in 80% of patients.
Conclusion Our research leads us to the conclusion that long PFN is a dependable implant that promotes little soft tissue damage and a high rate of bone union for subtrochanteric fractures. Although the procedure is technically challenging, intramedullary fixation offers advantages in terms of biology and biomechanics. It will take a lot of patience and gradual learning to make this procedure really least invasive.