Fixation of Subtrochanteric Fracture of the Femur: Our Experience 76-80
Dr. Chakraborty M.K.
Prof & HOD, Orthopaedics Department,
Manipal College of Medical Sciences, Pokhara, Nepal.
Introduction: Subtrochanteric fracture of the femur is a variant of the peritrochanteric fracture of the femur. It extends upto 5 cm below the lesser trochanter. The incidence is relatively much lower (3.9% of all the proximal femoral fractures). It is common in the older population with low energy trauma along with osteoporosis and in younger patients with high energy trauma. This is also the commonest site for a pathological fracture. Pathophysiological and biomechanical studies have shown that the subtrochanteric region is the most stressed area which concentrates stress on the implant and this is difficult to treat due to complications. With the improved knowledge and understanding of the fracture pattern, specific treatment options with successful results of improved quality may be obtained.
Material and Methods: A total of 12 cases of subtrochanteric fracture of the femur which were admitted in the Orthopaedic Dept, Manipal Teaching Hospital, Pokhara, Nepal, from Jan, 2010 to July, 2011, were selected in our study. The classification of the fracture was done by using the Russell and Taylorâ€™s classification for simplicity and it is the one which is currently mostly used for clinical use. Various implants like locking plate, proximal femoral nail (PFN), dynamic hip screw (DHS) and K-nail were used for fracture fixation. Clinical and radiographic analyses were done at a follow up of 3 weeks, 6 weeks, 3 months, 6 months and 1 year.
Results: Out of 12 cases, 9 were males and 3 were female.s K-nail fixation was done in one case of pathological fracture. Three locking plates, 4 DHS and 4 PFN were done. All the fractures united with good to excellent results, with few complications like mild restriction of the hip range of motion, mild varus deformity and a shortening of 2 cm.
Conclusion: With the various choices of implants for the fixation of subtrochanteric fracture of the femur, PFN, in our opinion, gave the best fixation with excellent results. We recommend PFN as a reliable cephalomedullary implant for the fixation of subtrochanteric fracture of the femur.