Original Research Article
Year: 2018 | Month: September | Volume: 5 | Issue: 9 | Pages: 81-86
A Prospective Observational Study of Clinical, Functional and Radiological Assessment of Unstable Intertrochanteric Fracture of Femur in Elderly Patients Treated with Proximal Femoral Nail Antirotation Using Harris Hip Score
Dr. Akshay Jain1, Dr. Lokesh Gudda Naik2, Dr. Pawal Gajendra Prabhakar1, Dr. Ankit Jain3
1Senior Registrar, Nanavati Super Specialty Hospital, Mumbai, India.
2Associate Consultant, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, India,
3Resident, Gandhi Medical College, Bhopal, Madhya Pradesh, India.
Corresponding Author: Dr. Lokesh Gudda Naik
ABSTRACT
Background: The incidence of unstable intertrochanteric fracture in elderly is rising because of increased age and with low bone mineral density. The presence of osteoporosis in intertrochanteric fractures is important because fixation of the proximal fragment depends entirely on the quality of cancellous bone present. The surgical stabilization of unstable intertrochanteric fractures remains a persistent challenge. The purpose of this study is to study the effectiveness and drawbacks of one such newer intramedullary device, Proximal Femoral Nail Antirotation in management of intertrochanteric fractures.
Patients and method: After obtaining clearance from hospital ethical board, patients who underwent PFNA for unstable intertrochanteric fractures at a tertiary care center, Mumbai, who have given written and informed consent. Patients fitting into inclusion criteria would form the study group. Sample size was calculated using Post-hoc analysis sample size calculator. Data collected by interviews, observation of clinical and radiological findings and assessment of function done using Harris hip score. Categorical data was analyzed by using Chi-square test and comparison of results done using Paired t test.
Results: The study comprised of 40 patients, with a mean age of mean age 77± 8.93 years who suffered unstable fracture intertrochanteric femur, due to either trivial fall (82.50%) or RTA (17.50%) and managed by cephalomedullary nailing using Proximal Femoral Nai Antirotation at our centre. Majority of the patients had quality of reduction; Majority of patients took 14 weeks for union with mean union time of 14.2 weeks with standard deviation of ± 1.29. Patients were asked to follow up routinely, with post operative follow up ranging from minimum of 20 weeks to 9 months. At final follow up following results obtained according to Harris Hip Score, were- 45% patients Excellent, 32.50% patients-Good, 20% patients- Fair, 2.50% patients-Poor.
Conclusions: The intertrochanteric fracture in elderly patients treated with cephalomedullary nailing using proximal femoral nail-antirotation, which has biomechanical advantage of helical blade providing bone compaction, increasing surface area and better anchorage in femoral head, which showed favorable outcome by retarding rotation and varus collapse and prevents medialization by acting as a central pillar.
Key words: Intramedullary; Intertrochanteric fracture; AO & OTA classification; Singh’s index; Cephalomedullary Femoral Nail; Proximal femoral nail antirotation; Helical blade; Harris hip score.
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