To compare the clinicoradiological outcome of various operative techniques and fixation devices in treatment of subtrochanteric fractures
Abstract
Background: There are various operative techniques and fixation devices in treatment of subtrochanteric fractures. The objective of treatment is restoration of optimal functions in the shortest possible time by the safest and most dependable method of treatment.
Aim: To compare the clinicoradiological outcome of various operative techniques and fixation devices in treatment of subtrochanteric fractures and its variants. To compare the efficacy of various operative techniques in management of subtrochanteric fractures and its variants. To assess efficiency of various fixation devices in different (A-O) types of subtrochanteric fractrues and to compare our results with those available in literature.
Methods: This prospective study was conducted in department of orthopedic surgery, in a span of two years. 38 Cases of subtrochanteric fractures and two types of extensions of subtrochanteric fractures admitted in orthopedics wards and treated by various operative methods were included in the study.
Results: Malunion was seen in 3 cases and infection in 2 cases. Excellent and good results were seen in most of the cases fixed with intramedullary devices 35% & 39% respectively) and these using closed techniques (38% & 43% respectively). Majority of excellent result (52%) were seen in cases fixed with Proximal Femoral Nail. Most of the cases fixed using Dynamic Condylar Screw and Dynamic Hip Screw had fair to good results.
Conclusion: Successful management of a case of subtrochanteric fracture is an exercise in balancing mechanical and biological consideration in maximize the likelihood of rapid healing and full restoration of function with minimal risk of complications at the least cost to the patient and society
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References
2. Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res. 1984; 2(3): 297-305. doi:10.1002/jor. 1100020312
3. Hotz TK, Zellweger R, Kach KP. Minimal invasive treatment of proximal femur fractures with the long gamma nail: indication, technique, results. J Trauma. 1999; 47(5): 942-5. doi:10.1097/00005373-199911000-00023
4. Curtis MJ, Jinnah RH, Wilson V, Cunningham BW. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation. Injury. 1994;25(2):99-104.doi: https://doi.org/10.1016/ 0020-1383(94)90111-2
5. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002; (399):110-8. doi:10.1097/00003086-200206000-00013
6. Anglen JO, Weinstein JN; American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. 2008;90(4):700-7. doi: 10.2106/JBJS.G.00517.
7. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002;84(3):372-81.
8. Yadav S, Sinha S, Luther E, Arora NC, Prasad M, Varma R. Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center. Chinese J Traumatol. 2014; 17(3): 1415. doi: https://doi.org/10. 3760/ cma.j. issn.1008-1275.2014.03.004
9. Vidyadhara S, Rao SK. One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly--randomised clinical trial. Injury. 2007 Jul; 38(7):806-14. Epub 2006 . doi:10.1016/j.injury.2006.08.050
10. Radford PJ, Howell CJ. The AO dynamic condylar screw for fractures of the femur. Injury. 1992; 23(2): 89-93.doi: https: //doi. org/10. 1016/0020-1383 (92) 90039-U
11. Kulkarni SG, Varshneya A, Kulkarni GS, Kulkarni MG, Kulkarni VS, Kulkarni RM. Antegrade inter-locking nailing for distal femoral fractures. J Orthop Surg (Hong Kong). 2012; 20(1):48-54. doi:10. 1177/ 230949901202000110
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