Vol 2 Issue 1 Jan – Apr 2014 page 35-38 Suranigi SM, Shetty N, Shah HM

Author: Shishir Murugharaj Suranigi[1], Naresh Shetty[2], Harshad Mohan Shah[2]

[1]Pondicherry Institute of Medical Sciences,Pondicherry-605014, India.
[2] M.S.Ramaiah Medical College and Hospitals, Bangalore-560054.

Institute where research was conducted: M.S.Ramaiah Medical College and Hospitals, Bangalore-560054
College Affiliation of Thesis: Rajiv Gandhi College of Health Sciences, Bangalore (R.G.U.H.S), Karnataka, India.
Year of Acceptance: 2010

Address of Correspondence
Dr.Shishir.S.M,
Assistant Professor,
Department of Orthopaedics,
Pondicherry Institute of Medical Sciences,
Pondicherry-605014, India
Email: shishir100@gmail.com

Background: Subtrochanteric fractures are among the common fractures experienced in the current orthopaedic practice. Selection of implant still remains using the surgeon. The pros and cons from the Gamma nail happen to be well-established in a number of studies done previously, usually by evaluating the outcomes using the Dynamic hip screw (DHS). This research handles the comparison of Proximal femoral nailing (PFN) versus Dynamic hip screw (DHS) in management of subtrochanteric fractures.
Methods: This research was conducted in M. S. Ramaiah Hospitals from October 2007 to August 2009. During this time period 50 installments of adult patients with subtrochanteric fractures of femur were selected based on the inclusion criteria and classified based on Seinsheimer’s classification.
Results: We discovered that PFN was better than DHS in lots of ways for example reduced intra-operative bloodstream loss, lesser operative time, reduced radiation exposure, less quantity of limb shortening, reduced stay in hospital, lesser infection rates and early mobilization.

Conclusion: Nailing has the benefit of supplying rotational in addition to axial stability in the event of subtrochantric fractures allowing a quicker postoperative restoration of walking ability, in comparison with the dynamic hip screw.
Key Phrases: Subtrochanteric fractures Proximal Femoral Nailing Dynamic Hip screw, Reverse oblique subtrochanteric fractures.

Subtrochanteric fractures are among the common fractures experienced in the current orthopaedic practice. The incidence of subtrochanteric femoral fractures has elevated considerably during recent decades, which inclination will most likely continue soon because of the considerable rise in the existence expectancy resulting in an growing geriatric population. Many treatments can be found. The aim of treating these fractures is stable fixation, which enables early mobilisation from the patient. The pros and cons from the original style of the Gamma nail happen to be well-established in a number of studies done previously, usually by evaluating the outcomes using the dynamic hip screw (DHS). Within this context there’s insufficient data available a good alternative, the proximal femoral nail (PFN), and it is merits in the treating of subtrochanteric fractures. The current study ended to check the pros and cons of proximal femoral nail over dynamic hip screw among patients with subtrochanteric fracture.

Aims and Objectives

The primary purpose of this dissertation ended up being to:
I)Study the different sorts of subtrochanteric fractures.
ii)Read the concepts and control over subtrochanteric fractures with proximal femoral nailing and DHS.
iii)To critically evaluate both groups for
1.Intra-operative bloodstream loss, time period of surgery and intra-operative radiation exposure.
2.Duration in the day’s surgery to mobilization.
3.Infection rates.
4.Time period of remain at hospital.
5.Implant failure rates.
6.Union rates.
7.Go back to normal function.
8.Residual disability or deformity.
iv)Assessment of results according to subjective parameters, objective parameters and radiological findings.
Within this study, an effort has been created to examine the literature and compare our results along with other studies.

It was a potential randomized study conducted in M. S. Ramaiah Hospitals from October 2007 to August 2009. During this time period 50 installments of adult patients with subtrochanteric fractures of femur were selected based on the inclusion criteria. Alternate patients who satisfied the inclusion and exclusion criteria went through PFN and DHS correspondingly.

INCLUSION CRITERIA
a)Age: 18 yrs
b)Sex: Both sexes
c)All kinds of subtrochanteric fractures given
proximal femoral nail or Dynamic hip screw.
d)No specific time period of illness.

a) Previous surgery from the proximal femur.
b) Pathologic fractures apart from brittle bones.
c)Ongoing chemotherapy or irradiation treatment because of malignancy.
d)Polytrauma.
e)Those who were not able to provide consent.

The fractures were classified based on Seinsheimer’s classification. Type IIIA constituted maximum number of instances (n=20) with 12 in PFN group and eight in DHS group adopted by Type IV (n=08) with 2 in PFN group and 6 in DHS group. Remainder of 22 patients belonged to Type IIA(n=02), Type IIB(n=05), Type IIC(n=05), Type IIIB(n=05) and kind V(n=05). There have been no Type I pattern of fractures within our study. From the 50 patients, 26 of these went through fixation with Proximal Femoral nailing and rest 24 of these were given DHS regardless of their fracture pattern. From the 50 patients, 48 patients were readily available for follow-up. Within our series maximum age was 96 many the least 18 years(mean age=62.36 years). Maximum patients were of the 60-eighty years age bracket(n=19). Males were 37 and some women 13. Right side was affected in 24 cases and left in 26 cases. The most typical mode of injuries within our series were trivial fall (n=35), Traffic Accidents (RTA) comprising 13 cases and adopted by fall from height by 50 percent cases. All patients were treated on elective basis. Surgery was performed typically of three days with a variety of 1-11 days. The typical time taken for DHS procedure was 124.58 minutes when compared with PFN that was 102.3 minutes.The typical time period of radiation exposure was 56.35 seconds for nailing when compared with 96.25 seconds for DHS procedure. The typical quantity of bloodstream loss was 208.7 ml for PFN procedure and 483.33 ml for DHS procedure. In PFN Series, Postero-Medial cortical defect was observed in 4 cases that iliac cancellous bone grafting ended whereas bone grafting was needed in 10 installments of DHS Series.
The intra-operative complications experienced during proximal femoral nailing are listed below:
1.Jamming from the nail within the proximal fragment while insertion was noted in a single situation, requiring progressive reaming from the proximal fragment and using a lesser diameter nail.
2.In ten cases we’d to complete ‘free hands technique’ for distal screw locking because of mismatch from the Jig and nail,
3.In a single situation, fixation from the fracture happened in varus angulation.
4.In a single situation, iatrogenic fracture from the lateral cortex from the proximal fragment was noted, that was minimally displaced. No intervention ended for your fracture. Standing and walking was delayed publish-operatively.
5.In six in our cases we’d to do open reduction, because of wide displacement from the fragments .
6.In a single situation, with delay in surgery of 11 days was noted because the patient wasn’t fit to become adopted for surgery. We’d difficulty in decrease in the fracture within this patient, therefore the fracture site needed to be opened up up for reduction. They were generally observed in Type IV. V fractures as well as in obese individuals. No intra-operative complications were experienced during DHS procedure. Within our DHS series, we’d a situation of wound infection in the operative site which needed intravenous antibiotics for 3 days. Wound healed without resorting to any more intervention. No publish-operative complications were observed in PFN series. The typical time taken for mobilization from the moment of surgery for PFN series was 1.five days as well as for DHS series was 2.12 days. The typical time period of stay in hospital following surgery was 7.9 days varying from 5-fourteen days within the PFN series and 12.04 days varying from 5-20 days within the DHS series. There wasn’t any mortality within this study. The typical time period of follow-up was 15 several weeks varying from 5 – 26 several weeks, which 2 patients were lost to follow-up, one out of DHS series along with other in PFN series. Both patients were lost throughout the second month of follow-up. In PFN series, from the 26 cases, 10 cases demonstrated union at 12 days, 7 cases demonstrated union at 14 days duration, 4 cases demonstrated union at 18 days duration. 4 installments of delayed union were seen. 2 installments of delayed union needed dynamization that have been adopted up till bony union, which required 7 several weeks and eight several weeks correspondingly. Two other cases needed bone grafting in the fracture site, which u . s . at 6 several weeks and seven several weeks correspondingly. One situation of breakage of implant in situ at 5 several weeks was observed. Patient had damaged the implant following a fall in your own home. It had been given implant removal and re-nailing with PFN and bone grafting. Fracture u . s . after 18 days of re-nailing. In DHS series, from the 24 cases, 8 cases demonstrated union at 12 days duration, 6 cases demonstrated union at 14 days duration, 3 cases demonstrated union at 18 days duration. 3 installments of delayed union were seen, that bone grafting in the fracture site ended at 8weeks, 10weeks and 12 days. Fracture subsequently u . s . after 10 days, 10 days and 14 days correspondingly from the moment of bone grafting. Three installments of breakage of implant in situ were observed at 12 days, 20 days and 25 days. A couple of that have been treated by implant removal and repeat DHS application with bone grafting. They u . s . after 14 days and 16 days correspondingly. Other situation was treated by implant removal and nailing with gamma nail and bone grafting, which u . s . after 20 days in the second surgery. Bony union was achieved in 24 from the 26 cases (92.3%) in PFN series when compared with 20 out 24 cases (83.33%) in DHS series. 69.33% from the cases had great results in PFN series when compared with 70.8% in DHS series.

Within our series we discovered that PFN was better than DHS in lots of ways for example reduced intra-operative bloodstream loss, lesser operative time, reduced radiation exposure, less quantity of shortening, reduced stay in hospital, lesser infection rates and early mobilization.
We’ve figured all reverse oblique fractures should be managed by PFN only as the likelihood of failure of fixation are extremely high with extra-medullary devices.

Nailing has the benefit of supplying rotational in addition to axial stability in the event of sub-trochanteric fractures allowing a quicker postoperative restoration of walking ability, in comparison with the DHS. Their nails are load-discussing implants, whereas extra-medullary products are load-bearing. Proximal femoral nailing results in a shorter lever arm, which means a lesser bending moment along with a decreased rate of mechanical failure 52 .

Subtrochanteric fractures Proximal Femoral Nail Dynamic Hip screw reverse oblique subtrochanteric fractures

1.Robert W Bucholz, James D Heckman, Charles M Court-Brown, Rockwood and Green’s “FRACTURES IN ADULTS” volume 2, sixth edition pages1827-1844.
2.G S Kulkarni, Rajiv Limaye, Milind Kulkarni, “Intertrochanteric Fractures – Current Concept Review” Ind J Orth, 2006, Vol 40, 16-23.
3.David G. Lavelle. Fractures and dislocations chapter-52 in CAMPBELL’S OPERATIVE ORTHOPAEDICS, tenth edition. VOL-3 pages 2897-2908.
‘4.The association old, race and sex using the location of proximal femoral fractures in elderly’. JBJS 1993 75(5), 752-9.
5.Boyd HB, GRIFFIN “classification and management of trochanteric fractures” Arch surgery, 1949 58 853-866.
6.Fielding JW: Subtrochanteric fractures, Clin Orthop 92:86, 1973
7.Pelet S, Arlcttaz Y, Chevalley F. “Osteosynthesis of pertrochanteric and subtrochanteric fractures with 900 blade plate versus Gamma nail-A randomized prospective study”. SWISS-SURG 2001 7(3) 126-33.
8.Klemm K, Schellman D: Dynamische und statische Verriegelund plusieurs Marknagels, Mschr Unfallheilk 75:568, 1972
9.Seinsheimer “subtrochanteric fractures from the femur”. JBJS, 1978, 60(A), 300-306.
10.David A, Von Der heyde D, Pommer A. Therapeutic options in trochanteric fractures” orthopaedics 200029(4)294-30
11.Harper MC, Walsh T: Ender nailing for peritrochanteric fractures from the femur: an analysis of indications, factors associated with mechanical failure, and postoperative results, J Bone Joint Surg 67A:79, 1985
12.Kinast C, Bolhofner BR, Mast JW, Ganz R: Subtrochanteric fractures from the femur: outcomes of treatment using the 95-degree condylar blade-plate, Clin Orthop 238:122, 1989.
13.Robert j Medoff “A New Device for that fixation of unstable pertrochanteric fractures from the hip”JBJS, 1991, 73(A), 1192-1199.
14.Halder SC: The gamma nail for peritrochanteric fractures, J Bone Joint Surg 74B:340, 1992.
15.K S Leung, W S SO, W Y Shen, P W Hui” gamma nails and dynamic hip screws for peritrochanteric fractures” JBJS (Br) 1992 74(B):345-51.
16.Shepherd F. Rosenblum, Frederick Zuckerman” A Biomechanical look at the gamma nail” JBJS (Br) 1992 74(B):352-7.
17.Philip J. Radford, Maurice needoff, john k Webb” a potential randomized comparison from the dynamic hip screw and also the gamma locking nail” JBJS, 1993 75(B) 789-793.
18.Martyn J. Parker” a brand new mobility score for predicting mortality after hip fracture” JBJS, 1993 75(B) 797-799.
19.“Treatment of subtrochanteric fractures with AO dynamic condylar screw”.J Injuries 1993 February, 24(2) 90-2.
20.“Subtrochanteric fractures from the femur given Zickel nail”Arch-ortho.Belg, 1994 ( 60) 129-33.
21.Taglang G, Favrel E, “77 patients ,mean age 75 years, twelve months follow up”. Paper given to advanced course in Intramedullary locking nailing, Courchel, France.1991.
22.Vanderschof P. et al. 1995. “A overview of 161 subtrochanteric fractures- risks influencing outcome: age, fracture level and fracture pattern”. Unfallchirug, 98(5):265-71.
23.Simmermacher RK, Bosch AM, Van der Werken C: “The AO/ASIF proximal femoral nail (PFN): A brand new device to treat unstable proximal femoral fractures”. Injuries 30:327–332, 1999.
24.Sturdy DCR, Descamps PY, Krallis P, et al: Utilization of an intramedullary hip screw in contrast to a compression hip screw having a plate for intertrochanteric femoral fractures, J BoneJoint Surg 80A:618, 1998.
25.L J Domingo” trochanteric fractures given a proximal femoral nail” worldwide orthopaedics (SICOT) 2001, 25:298-301.
26.Christian Boldin” the proximal femoral nail-a small invasive management of unstable proximal femoral fractures” Acta Orthop Scand2003:74(1) 53-58.
27.Ramakrishnan M, Prasad SS, Parkinson RW, Kaye JC: “Management of subtrochanteric femoral fractures and metastases using lengthy proximal femoral nail”. Injuries 35:184–190, 2004.
28.Ely L Steinberg, Nehemia Blumberg, Shmuel Dekel “The fixion proximal femur nailing system: biomechanical qualities from the nail along with a cadaveric study” Journal of biomechanics38 (2005)63-68.
29.Daniel F A Menezes, Axel Gamulin, and Bruno Noesberger. “Is the Proximal femoral nail a appropriate implant to treat all trochanteric Fractures? ” clin ortho and rel research 2005 439, 221-227.
30.Pajarinen J, “ pertrochanteric femoral fractures given an engaged hip screw or perhaps a proximal femoral nail. A randomized study evaluating publish operative rehabilitation” JBJS (Br) 2005, 87(1) 76-81.
31.Gray’s Anatomy, 16th Edition, pages 151-153.
32.DeLee JC: Fractures and dislocations from the hip. In Rockwood CA Junior, Eco-friendly DP, eds: Fractures in grown-ups, erectile dysfunction 2, Philadelphia, 1984, JB Lippincott.
33.Mller ME, Allgwer M, Schneider R, Willenegger H: Manual of internal fixation: techniques suggested through the AO-ASIF group, erectile dysfunction 3, Berlin, 1991, Springer-Verlag.
34.Jesse C Delee. Rockwood and Green’s Fractures in grown-ups. Chapter 18, 3rd Edition 1991, Charles A. Rockwood, David P. Eco-friendly and Robert W. Bucholz JB(eds), Lippincott Company, Vol 2, 1481-1651.
35.Kaufer H, Matthews LS, Sonstegard D: Stable fixation of intertrochanteric fractures: a biomechanical evaluation, J Bone Joint Surg 56A:899, 1974.
36.Kulkarni G S. Management of Trochanteric fractures from the hip by Modified Richard’s Compressing and Collapsing screw. Indian Journal of Orthopaedics 1984 18(1): 30-34.
37.Kenneth J. Koval and Frederick D. Zuckerman: Rockwood and Green’s Fracture in grown-ups, Chapter 39, fifth Edition, 2001-edited by Robert W.Bucholz and James D. Heckman, J.B. Lippincott Company, Vol 2, 1635-1663.
38.Iraqi A A. “External fixation in Trochanteric fractures within the Elderly”. Indian Journal of Orthopaedics 2001, 35(2): 31-33.
39.Watson Johnson, “Injuries from the thigh”, chapter 30 in Watson-Johnson Fractures and Joint Injuries, sixth Edition vol 2 999-1003.
40.Michael R. Baumgartner and Thomas F. Higgins. Chapter 38 in Rockwood and Green’s “Fractures in Adults” fifth Edition vol 2 1579-94.
41.Russell TA, Taylor JC: Subtrochanteric fractures from the femur. In Browner BD, Jupiter JB, Levine AM, Trafton PG, eds: Skeletal Trauma, erectile dysfunction 2, Philadelphia, 1992, WB Saunders,
42.Waddell JP: Subtrochanteric fractures from the femur: overview of 130 patients, J Trauma 18:513, 1978
43.Kyle Richard F, Campbell Sara J. Intertrochanteric Fractures, Chapter-40 in Michael W Chapman Operative Orthopaedics. Vol 1, pages 600-603.
44.Habernek H, Wallner T, Aschauer E, Schmid L: Comparison of Ender nails, dynamic hip screws, and Gamma nails in treating peritrochanteric femoral fractures, Orthopaedics 23:121, 2000.
45.Mohamed M N, Harrington J, Heam TC. “Biochemical analysis of Medoff’s sliding plate” J Trauma 2000 48(1) 93-100.
46.Bridle SH, Patel AD, Bircher M, et al: Fixation of intertrochanteric fractures from the femur: a randomised prospective comparison from the gamma nail and also the dynamic hip screw, J Bone Joint Surg 73B:330, 1991.
47.Mc Kibbin B. The Biology of fracture healing in lengthy bones. JBJS(Br)1978 60 150-62.
48.Valverde J A, Alonso M G, Porro J G, Rueda D, Larrauri P M, Soler J J. “Use from the Gamma nail within the treatment o fractures from the proximal femur”. Clin Orthop 1998 350 56-61.
49.Pavelka T, Kortus J, Linhart M. “Osteosynthesis of proximal femoral fractures using short proximal femoral nails”. Acta Chir Orthop Traumatol Cech, 2003 70(1) 31-8.
50.DeLee JC, Clanton TO, Rockwood CA Junior: Closed management of subtrochanteric fractures from the femur inside a modified cast-brace, J Bone Joint Surg 63A:772, 1981.
51.Adams CI, Robinson CM, Court-Brown CM, McQueen MM: Prospective randomized controlled trial of the intramedullary nail versus dynamic screw and plate for intertrochanteric fractures from the femur, J Orthop Trauma 15:394–400, 2001.
52.Fractures Kuzyk et al. Intramedullary Versus Extramedullary Fixation for Subtrochanteric fractures, Journal of Orthopaedic Trauma: This summer 2009 Volume 23 – Issue 6 – pp 465-470.

How you can Cite this short article: Suranigi SM, Shetty N, Shah HM. Study evaluating the benefits of proximal femoral nail over Dynamic hip screw among patients with subtrochanteric fractures. Journal Medical Thesis 2014 Jan-Apr 2(1): 35-38

Vol 2 Issue 1 Jan – Apr 2014 page 35-38 Suranigi SM, Shetty N, Shah HM

Author: Shishir Murugharaj Suranigi[1], Naresh Shetty[2], Harshad Mohan Shah[2]

[1]Pondicherry Institute of Medical Sciences,Pondicherry-605014, India.
[2] M.S.Ramaiah Medical College and Hospitals, Bangalore-560054.

Institute where research was conducted: M.S.Ramaiah Medical College and Hospitals, Bangalore-560054
College Affiliation of Thesis: Rajiv Gandhi College of Health Sciences, Bangalore (R.G.U.H.S), Karnataka, India.
Year of Acceptance: 2010

Address of Correspondence
Dr.Shishir.S.M,
Assistant Professor,
Department of Orthopaedics,
Pondicherry Institute of Medical Sciences,
Pondicherry-605014, India
Email: shishir100@gmail.com

Background: Subtrochanteric fractures are among the common fractures experienced in the current orthopaedic practice. Selection of implant still remains using the surgeon. The pros and cons from the Gamma nail happen to be well-established in a number of studies done previously, usually by evaluating the outcomes using the Dynamic hip screw (DHS). This research handles the comparison of Proximal femoral nailing (PFN) versus Dynamic hip screw (DHS) in management of subtrochanteric fractures.
Methods: This research was conducted in M. S. Ramaiah Hospitals from October 2007 to August 2009. During this time period 50 installments of adult patients with subtrochanteric fractures of femur were selected based on the inclusion criteria and classified based on Seinsheimer’s classification.
Results: We discovered that PFN was better than DHS in lots of ways for example reduced intra-operative bloodstream loss, lesser operative time, reduced radiation exposure, less quantity of limb shortening, reduced stay in hospital, lesser infection rates and early mobilization.
Conclusion: Nailing has the benefit of supplying rotational in addition to axial stability in the event of subtrochantric fractures allowing a quicker postoperative restoration of walking ability, in comparison with the dynamic hip screw.
Key Phrases: Subtrochanteric fractures Proximal Femoral Nailing Dynamic Hip screw, Reverse oblique subtrochanteric fractures.

Subtrochanteric fractures are among the common fractures experienced in the current orthopaedic practice. The incidence of subtrochanteric femoral fractures has elevated considerably during recent decades, which inclination will most likely continue soon because of the considerable rise in the existence expectancy resulting in an growing geriatric population. Many treatments can be found. The aim of treating these fractures is stable fixation, which enables early mobilisation from the patient. The pros and cons from the original style of the Gamma nail happen to be well-established in a number of studies done previously, usually by evaluating the outcomes using the dynamic hip screw (DHS). Within this context there’s insufficient data available a good alternative, the proximal femoral nail (PFN), and it is merits in the treating of subtrochanteric fractures. The current study ended to check the pros and cons of proximal femoral nail over dynamic hip screw among patients with subtrochanteric fracture.

Aims and Objectives

The primary purpose of this dissertation ended up being to:
I)Study the different sorts of subtrochanteric fractures.
ii)Read the concepts and control over subtrochanteric fractures with proximal femoral nailing and DHS.
iii)To critically evaluate both groups for
1.Intra-operative bloodstream loss, time period of surgery and intra-operative radiation exposure.
2.Duration in the day’s surgery to mobilization.
3.Infection rates.
4.Time period of remain at hospital.
5.Implant failure rates.
6.Union rates.
7.Go back to normal function.
8.Residual disability or deformity.
iv)Assessment of results according to subjective parameters, objective parameters and radiological findings.
Within this study, an effort has been created to examine the literature and compare our results along with other studies.

It was a potential randomized study conducted in M. S. Ramaiah Hospitals from October 2007 to August 2009. During this time period 50 installments of adult patients with subtrochanteric fractures of femur were selected based on the inclusion criteria. Alternate patients who satisfied the inclusion and exclusion criteria went through PFN and DHS correspondingly.

INCLUSION CRITERIA
a)Age: 18 yrs
b)Sex: Both sexes
c)All kinds of subtrochanteric fractures given
proximal femoral nail or Dynamic hip screw.
d)No specific time period of illness.

a) Previous surgery from the proximal femur.
b) Pathologic fractures apart from brittle bones.
c)Ongoing chemotherapy or irradiation treatment because of malignancy.
d)Polytrauma.
e)Those who were not able to provide consent.

The fractures were classified based on Seinsheimer’s classification. Type IIIA constituted maximum number of instances (n=20) with 12 in PFN group and eight in DHS group adopted by Type IV (n=08) with 2 in PFN group and 6 in DHS group. Remainder of 22 patients belonged to Type IIA(n=02), Type IIB(n=05), Type IIC(n=05), Type IIIB(n=05) and kind V(n=05). There have been no Type I pattern of fractures within our study. From the 50 patients, 26 of these went through fixation with Proximal Femoral nailing and rest 24 of these were given DHS regardless of their fracture pattern. From the 50 patients, 48 patients were readily available for follow-up. Within our series maximum age was 96 many the least 18 years(mean age=62.36 years). Maximum patients were of the 60-eighty years age bracket(n=19). Males were 37 and some women 13. Right side was affected in 24 cases and left in 26 cases. The most typical mode of injuries within our series were trivial fall (n=35), Traffic Accidents (RTA) comprising 13 cases and adopted by fall from height by 50 percent cases. All patients were treated on elective basis. Surgery was performed typically of three days with a variety of 1-11 days. The typical time taken for DHS procedure was 124.58 minutes when compared with PFN that was 102.3 minutes.The typical time period of radiation exposure was 56.35 seconds for nailing when compared with 96.25 seconds for DHS procedure. The typical quantity of bloodstream loss was 208.7 ml for PFN procedure and 483.33 ml for DHS procedure. In PFN Series, Postero-Medial cortical defect was observed in 4 cases that iliac cancellous bone grafting ended whereas bone grafting was needed in 10 installments of DHS Series.
The intra-operative complications experienced during proximal femoral nailing are listed below:
1.Jamming from the nail within the proximal fragment while insertion was noted in a single situation, requiring progressive reaming from the proximal fragment and using a lesser diameter nail.
2.In ten cases we’d to complete ‘free hands technique’ for distal screw locking because of mismatch from the Jig and nail,
3.In a single situation, fixation from the fracture happened in varus angulation.
4.In a single situation, iatrogenic fracture from the lateral cortex from the proximal fragment was noted, that was minimally displaced. No intervention ended for your fracture. Standing and walking was delayed publish-operatively.
5.In six in our cases we’d to do open reduction, because of wide displacement from the fragments .
6.In a single situation, with delay in surgery of 11 days was noted because the patient wasn’t fit to become adopted for surgery. We’d difficulty in decrease in the fracture within this patient, therefore the fracture site needed to be opened up up for reduction. They were generally observed in Type IV. V fractures as well as in obese individuals. No intra-operative complications were experienced during DHS procedure. Within our DHS series, we’d a situation of wound infection in the operative site which needed intravenous antibiotics for 3 days. Wound healed without resorting to any more intervention. No publish-operative complications were observed in PFN series. The typical time taken for mobilization from the moment of surgery for PFN series was 1.five days as well as for DHS series was 2.12 days. The typical time period of stay in hospital following surgery was 7.9 days varying from 5-fourteen days within the PFN series and 12.04 days varying from 5-20 days within the DHS series. There wasn’t any mortality within this study. The typical time period of follow-up was 15 several weeks varying from 5 – 26 several weeks, which 2 patients were lost to follow-up, one out of DHS series along with other in PFN series. Both patients were lost throughout the second month of follow-up. In PFN series, from the 26 cases, 10 cases demonstrated union at 12 days, 7 cases demonstrated union at 14 days duration, 4 cases demonstrated union at 18 days duration. 4 installments of delayed union were seen. 2 installments of delayed union needed dynamization that have been adopted up till bony union, which required 7 several weeks and eight several weeks correspondingly. Two other cases needed bone grafting in the fracture site, which u . s . at 6 several weeks and seven several weeks correspondingly. One situation of breakage of implant in situ at 5 several weeks was observed. Patient had damaged the implant following a fall in your own home. It had been given implant removal and re-nailing with PFN and bone grafting. Fracture u . s . after 18 days of re-nailing. In DHS series, from the 24 cases, 8 cases demonstrated union at 12 days duration, 6 cases demonstrated union at 14 days duration, 3 cases demonstrated union at 18 days duration. 3 installments of delayed union were seen, that bone grafting in the fracture site ended at 8weeks, 10weeks and 12 days. Fracture subsequently u . s . after 10 days, 10 days and 14 days correspondingly from the moment of bone grafting. Three installments of breakage of implant in situ were observed at 12 days, 20 days and 25 days. A couple of that have been treated by implant removal and repeat DHS application with bone grafting. They u . s . after 14 days and 16 days correspondingly. Other situation was treated by implant removal and nailing with gamma nail and bone grafting, which u . s . after 20 days in the second surgery. Bony union was achieved in 24 from the 26 cases (92.3%) in PFN series when compared with 20 out 24 cases (83.33%) in DHS series. 69.33% from the cases had great results in PFN series when compared with 70.8% in DHS series.

Within our series we discovered that PFN was better than DHS in lots of ways for example reduced intra-operative bloodstream loss, lesser operative time, reduced radiation exposure, less quantity of shortening, reduced stay in hospital, lesser infection rates and early mobilization.
We’ve figured all reverse oblique fractures should be managed by PFN only as the likelihood of failure of fixation are extremely high with extra-medullary devices.

Nailing has the benefit of supplying rotational in addition to axial stability in the event of sub-trochanteric fractures allowing a quicker postoperative restoration of walking ability, in comparison with the DHS. Their nails are load-discussing implants, whereas extra-medullary products are load-bearing. Proximal femoral nailing results in a shorter lever arm, which means a lesser bending moment along with a decreased rate of mechanical failure 52 .

Subtrochanteric fractures Proximal Femoral Nail Dynamic Hip screw reverse oblique subtrochanteric fractures

1.Robert W Bucholz, James D Heckman, Charles M Court-Brown, Rockwood and Green’s “FRACTURES IN ADULTS” volume 2, sixth edition pages1827-1844.
2.G S Kulkarni, Rajiv Limaye, Milind Kulkarni, “Intertrochanteric Fractures – Current Concept Review” Ind J Orth, 2006, Vol 40, 16-23.
3.David G. Lavelle. Fractures and dislocations chapter-52 in CAMPBELL’S OPERATIVE ORTHOPAEDICS, tenth edition. VOL-3 pages 2897-2908.
‘4.The association old, race and sex using the location of proximal femoral fractures in elderly’. JBJS 1993 75(5), 752-9.
5.Boyd HB, GRIFFIN “classification and management of trochanteric fractures” Arch surgery, 1949 58 853-866.
6.Fielding JW: Subtrochanteric fractures, Clin Orthop 92:86, 1973
7.Pelet S, Arlcttaz Y, Chevalley F. “Osteosynthesis of pertrochanteric and subtrochanteric fractures with 900 blade plate versus Gamma nail-A randomized prospective study”. SWISS-SURG 2001 7(3) 126-33.
8.Klemm K, Schellman D: Dynamische und statische Verriegelund plusieurs Marknagels, Mschr Unfallheilk 75:568, 1972
9.Seinsheimer “subtrochanteric fractures from the femur”. JBJS, 1978, 60(A), 300-306.
10.David A, Von Der heyde D, Pommer A. Therapeutic options in trochanteric fractures” orthopaedics 200029(4)294-30
11.Harper MC, Walsh T: Ender nailing for peritrochanteric fractures from the femur: an analysis of indications, factors associated with mechanical failure, and postoperative results, J Bone Joint Surg 67A:79, 1985
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How you can Cite this short article: Suranigi SM, Shetty N, Shah HM. Study evaluating the benefits of proximal femoral nail over Dynamic hip screw among patients with subtrochanteric fractures. Journal Medical Thesis 2014 Jan-Apr 2(1): 35-38