Author(s): Sunkara Dinesh Chowdary1, Challa Ravi Kiran2, Cheekati Lalki3
Intertrochanteric fractures are one the common fractures encountered in today’s orthopaedic practice. Intertrochanteric fractures are devastating injuries that most commonly affect the elderly population, but not increased in the younger population. In young and healthy individuals, the injury results from high energy trauma, whereas in the elder age group, most of the fractures are osteoporotic resulting from a trivial fall.
MATERIALS AND METHODS
This study was conducted in Konaseema Institute of Medical Sciences, Amalapuram, from July 2013 to September 2016. During this period, adult patients with pertrochanteric fractures of femur were classified according to Boyd and Griffin classification and 40 patients were selected according to inclusion criteria. This study was conducted with due emphasis for clinical observation and analysis of results after surgical management of these fractures of femur with dynamic hip screw or proximal femoral nailing.
Anatomical results were assessed by presence or absence of shortening, range of movements and deformities. 70% of the cases had good results in PFN series as compared to 65% in DHS series. Functional results were assessed in the 40 cases. These constituted of 20 cases in PFN series and 20 cases in DHS series. In PFN series, results were excellent results in 7 cases, good in 6 cases, fair in 2 cases and poor in 5 cases. In DHS series, results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 4 cases.
An intertrochanteric fracture of the femur is common in the elderly due to osteoporosis and in young due to high velocity trauma. As the fracture is more common in the elderly, early reduction and internal fixation increases patient comfort, facilitates nursing care, helps in early mobilisation of the patient and decreases the duration of hospitalisation. Anatomical reduction can be achieved by closed manipulation or open methods. As the incidence of comminution is high, these fractures may require a stable reduction and internal fixation. Bone grafting is required if there is a deficiency. Osteosynthesis with 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. Proximal femoral nail has the advantage of collapse at fracture site and is biomechanically sound.