Rising trend of proximal femoral nail in therapy of Extracapsular Hip Fractures

  • Dr. Ajit Ganvir Assistant Professor, Department of Orthopaedics, Gandhi Medical College, Bhopal, MP, India
  • Dr. Deependra Sonkar Assistant Professor, Department of Orthopaedics, Gandhi Medical College, Bhopal, MP, India
  • Prof. Dr. Jiten Shukla Professor of Orthopaedics, Department of Orthopaedics, Gandhi Medical College, Bhopal, MP, India
  • Prof. Dr. Sanjeev Gaur Professor and Head, Department of Orthopaedics, Gandhi Medical College, Bhopal, MP, India
Keywords: Dynamic Hip Screw, Proximal Femoral Nail, Extracapsular Hip Fracture, Trend

Abstract

Introduction: Fracture distal to the capsular attachment i.e. pertrochanteric area of hip including intertrochanteric and sub trochanteric region called as extracapsular hip fractures. Management of these fractures is big challenge in acute trauma. Unstable Extracapsular hip fractures accounts for 2% of all hip fractures. Dynamic hip screw (DHS) has some surgical drawback in unstable extra capsular hip fractures leading to more usage of proximal femoral nail (PFN).

Aim of of Study: This study is undertaken to assess the changing patterns of Dynamic hip screw and Proximal femoral nail in extra capsular hip fractures.

Materials and Methods: This is a retrospective study from 2008 to 2014. The study included 786 patients (Mean age 66.2 years) who underwent Dynamic hip screw and Proximal femoral nail fixation for extracapsular hip fractures. Out of 786 patients, 508 patients had DHS fixation and 278 patients had PFN fixation.

Results: This study evaluated early complications and technical failures of both methods. Fracture classification used was AO type and patients were divided into two methods of fixation. Data analysis showed dramatically rising trend of PFN.

Conclusion: We have concluded that PFN was used aggressively in the last 3 years which may be due to the changing behavior of fracture pattern. It may be intrinsic attraction to new surgical techniques with the younger orthopaedic surgeons.

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References

1. Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures, Epidemiol Rev.1985;7:178-208. [PubMed]

2. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Number, Casts , and potential effect of postmenopousal estrogen. ClinOrthopRelat Res.1990;Mar(252):163-6. [PubMed]

3. Gulberg B, Duppe H, Nilsson B (1993) Incidence of Hip fracture in Malmo, Sweden (1950-1991).Bone 14 [Suppl 1]:23-29. [PubMed]

4. Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fracture of the intertrochanteric region of the femur. J. Bone Joint Surg Am.2001;83:643-50. [PubMed]

5. Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Stanbuch M, et al .Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporosis Int.2010;21(3):399-408[PubMed]. [PubMed]

6. Ekstrom W, Nemeth G, Samnegard E, Dalen N, Tidermark J, Quality of life after a subtrochantric fracture: a prospective cohort study on 87 elderly patients .Injury 2009;40(4):371-376[PubMed]. [PubMed]

7. Wiss DA, Brien WW. Sub trochanteric fracture of the femur. Results of treatment by interlocking nailing. ClinOrthop Relate Res. 1992; (283): 231- 236[PubMed]. [PubMed]

8. Doppelt SH (1980) The sliding compression screw. Today’s best answer for stabilization of inter trochanteric hip fractures OrthopClin North Am 11: 507-523. [PubMed]

9. Flores LA, Harrington IJ, Heller M. The stability of inter trochanteric fractures treated with a sliding screw-plate. J Bone Joint Surg Br 1990; 72: 37-40. [PubMed]

10. Simpson AH, Varty K, Dodd CA. Sliding hip screw: Modes of failure. Injury1989; 20: 227-31. [PubMed]

11. Hoffman R Haas NP. Femur : proximal. In: Rudei TP, Murphy WM, eds. AO principles of fracture management Stuttgart, etc: Thieme 2000: 441-54.

12. Nuber S, T Schonweiss, A Rutter. Stabilisation of unstable trochanteric femoral fracture. Dynamic hip screw (DHS) with trochanteric stabilsation plate vs proximal femoral nail (PFN). Unfallchirurg. Jan 2003;106(1):39-47.

13. Ruedi TP, Mureny WM. AO principles of fracture management. Stuttgart: Thieme 2001.

14. Tengre and J. Kjellander ; Antibiotic prophylaxis in operation on trochanteric femoral fractures; Scan J Prim health care sep 2002; 20 (3); 188-92.

15. Sadowski C, Lubbeke A, Saudan M et al (2002). Treatment of reverse and transverse intertrochanteric fractures with use of an intramedullary nail or 95 degree screw- plate: a prospective randomized study. J Bone Joint Surg Am 84 A; 372-381. [PubMed]

16. Rosenblum SF, Zuckerman JD, Kummer FJ, Ram BS. A biomechanical evoluation of the Gamma Nail. J Bone Joint Surg (Br) 1992; 74-B: 352-7. [PubMed]

17. Curtis MJ , Jinnah RH, Wilson V, Cunningham BW. Proximal femoral fractures: a biomechanical study to compare intramedullary or extra medullary fixation. Injury 1994 ; 25: 99- 104.

18. Flahiff CM, Nelson CL, Gruenwald JM, Hollis JM. A biomechanical evaluation of an intramedullary fixation device for intertrochanteric fractures. J Trauma 1993; 35: 23-27. [PubMed]

19. Radford PJ, Needoff M, Webb JK. A prospective randomized comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg 1993; 75-B: 789-793. [PubMed]

20. Herrera A, Domingo LJ, Calvo A, Martinez A. A comparative study of trochanteric fractures treated with the gamma nail or the proximal femoral nail. IntOrthop2002 ; 26: 365-9. [PubMed]

21. Muller ME, Nazarian S Koch P, SchatzkerJ , editors. The comprehensive classification of fractures of long bones.Springer, Berlin, 1990 pp 120. [PubMed]

22. Fogagnolo F, Kfuri M Jr, Paccola C. Intramedullary fixation of pertrochanteric hip fractures with the short AO- ASIF proximal femoral nail. Arch Orthop Trauma Surg 2004; 124: 31-37. [PubMed]

23. Perez JV , Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture- an autopsy study. Injury 26: 237-240.

24. Windoff J, Hollander DA, Hakimi M, Linhart W (2005) Pitfalls and complications in the use of proximal femoral nail. Langenbecks Arch Surg 390 (1): 59-65 Feb Epub 2004 Apr 15. [PubMed]

25. Bartonicek J, Dousa P, Skala- Rosenbaum J, Kostal R. Trochanteric fractures. A current concept review.UrazovaChirurgi 2001; 10.

26. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomized study comparing postoperative rehabilitation. J Bone Joint Surg 2005; 87 : 76-8.

27. Parker MJ ,Handoll HH, Gamma and other Cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2005; 4: CD 000093.
CITATION
DOI: 10.17511/ijmrr.2015.i4.084
Published: 2015-05-31
How to Cite
1.
Ganvir A, Sonkar D, Shukla J, Gaur S. Rising trend of proximal femoral nail in therapy of Extracapsular Hip Fractures. Int J Med Res Rev [Internet]. 2015May31 [cited 2024May3];3(4):424-9. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/254
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Original Article