European Journal of Molecular & Clinical Medicine

The most common hip fracture is an intertrochanteric femur fracture, which is more likely in older population with osteoporotic bones and with a male preponderance. The proximal femoral nail (PFN), developed by the AO/ASIF group, has demonstrated its stability as an implant in femoral fractures with peritrochanteric, intertrochanteric, or subtrochanteric fractures [6]. So, the current study was conducted with the aim of assessing the role of proximal femoral nail in the management of intertrochanteric femur fracture and its functional outcome.
Methods: The Department of Orthopaedics at Sree Uthradam Thirunal Academy of Medical Sciences Hospital, Thiruvananthapuram, Kerala, South India, undertook this current prospective cohort study from January 2021 to June 2022. On the basis of predefined inclusion and exclusion criteria, a total of 48 patients were included in present study. A pretested questionnaire was used to record patient details such as age, gender, type of fracture, time period of union of fracture in open and closed reduction, complications and functional outcome. The Boyd and Griffin classification was used to classify intertrochanteric fractures. Patients were followed up at 3, 6, and 12 weeks and finally at 6 months postoperatively for functional outcome as assessed by Kyle’s criteria. The statistical tests were considered if P value was <0.05.
Results: In our study, an aggregate of 48 patients were enrolled, male patients predominated (n=32) the study and there were 16 female patients. The mean age of patients was 48.57±8.13 years. In our study, Type I fracture were 4.1%, Type II fracture were 66.7%, Type III fracture were 6.3% and Type IV fracture were 22.9%. The difference in the time taken for union for fracture approached via closed and open reduction technique was not significant (p>0.05). In our study, the postoperative complications were screw failure (12.5%), and varus malalignment (4.2%). The functional outcome as excellent was enhanced as it was 20.8% at 3 months and 33.3% at 6 months.
Conclusion: Before being used by an orthopaedic surgeon, all latest implants and instrumentations must undergo a rigorous assessment. In our study, the proximal femoral nail, which was made use of to treat intertrochanteric fracture, achieved good results in terms of both functional and radiographic performance.

INTRODUCTION:
Intertrochanteric fractures are commonly seen in patients over 70yrs of age. In younger population, intertrochanteric fracture occurs due to high velocity trauma, whereas in elderly population, it is most often due to trivial trauma.Cephalomedullary device is used for management of intertrochanteric fracture
OBJECTIVES :
 To compare the surgical results in patients with inter-trochanteric femur fractures Treated by PFN with and without distal locking .
METHODOLOGY:  In a prospective study 40 patients were enrolled with mean age 59.05 years with proximal femur fracture which included 25females and 15 males who underwent Long proximal femoral nail with distally locked and distally unlocked. AO system of classification was used. 31 A1 was the commonest type. Operative time, overall fluoroscopy shots, intra-operative blood loss, the duration of hospitalization, and the surgical complications were noted. Patients were followed up at 6weeks, 3months, 6 months. Functional outcome assessed according to the Harris hip scoring system.
RESULTS:
            Mean age of 59.05 years in PFN without distal locking and 54.75 years in PFN with distal locking.  Mean duration of surgery in PFN without and with distal locking was 40.45 & 54.75 mints respectively.  Mean amount of blood loss  in PFN without  and with distal locking 154.7 ml and 206.3 ml respectively .Mean length of incision in PFN without  and with distal locking was 10.95  & 12.65 cm respectively.  Mean fluoroscopic time in PFN without and with distal locking was 61.3 & 71.3 shots respectively. Mean duration of hospital stay in Group A & B is 15.3 & 15.2 days respectively . Out of 40 cases no case was lost in follow up.  we had good to excellent results in 90%, fair in 10%, we had no case with poor results.
CONCLUSION:
             From this study, we consider that long proximal femoral nailing without distal locking shows subtle advantages for duration of surgery, amount of blood loss, incision length ,fluoroscopy exposure time ,post-op stiffness in stable  intertrochanteric fracture.

The most widespread internal fixation device used today is the fixed angle extramedullary device, such as a 95-degree lag screw and side plate or blade plate. This implant includes a large lag screw positioned in the center of the femoral neck and head and a side plate alongside the lateral femur. The screw-plate interface angle is changeable and depends on the anatomy of the patient and the fracture. A total of 30 patients who were admitted with intertrochanteric fractures that fitted into the inclusion criteria and managed surgically with proximal femoral nail were included in the study. In our series, Boyd and Griffin type II and type III contributed eighteen and six cases in each group, making to 60% and 20% followed by type IV contributing 6 cases making 20%. We performed closed procedure in 26 cases (87%) and open nailing in 4 cases (13%). The average duration of radiation exposure was 120 seconds, average duration of surgery was 95 minutes and average blood loss was 140 ml with 23% intraoperative complications

Objectives: To assess results of proximal femoral nail in the treatment of peri-trochanteric fracture of femur.
Methods: This study included 90 patients of proximal femur fracture admitted in our institute. The patients were informed about the study in all respects and informed consent was obtained from each patient.
Results: Results were evaluated using the Harris Hip Score. We had 45(50%) excellent, 31(34.44%) good, 12(17.8%) fair and 2(2.22%) poor results.
Conclusion: The Proximal Femoral Nail Can Be Considered The Most Rational Method of Treating Intertrochanteric and Sub-trochanteric Fractures, Especially the Unstable and Reverse Oblique Type. Also the learning curve is relatively less and hence can be performed well by most of the surgeons. Thus we can conclude that the Proximal Femoral Nail is after proper training and technique, a safe and easy implant option for treatment of complex peri-trochanteric fractures.

Objective: To evaluate clinical and functional outcome of unstable intertrochanteric and subtrochanteric fractures of femur treated with proximal femoral nailing with trochanteric stabilization plate.
Methods: In our study we included twenty patients of unstable intertrochanteric and subtrochanteric fracture of femur fixed with proximal femoral nailing with trochanteric stabilizing plate. Our study design is prospective and observational. Our study has maximum follow up of eighteen months and minimum of three months. Patients from third decade of life and onwards, presenting to orthopedic outpatient department in casualty or regular OPD with history pf household fall or minor or moderate trauma or sometime with road traffic accident.
Results: Twenty patients with unstable intertrochanteric and subtrochanteric fracture of femur fixed with proximal femoral nailing with trochanteric stabilizing plate, it was observed that six (30%) patients with Harris hip score between 90-100, nine (45%) patients with Harris hip score between 80-89, three (15%) patients with Harris hip score between 70-79 and two (10%) patients with Harris hip score between < 70. Also twenty patients we observed six (30%) patients with excellent result, nine (45%) with good result, three (15%) with fair result and two (10%) with poor result. There was three patients with infection, in one patient infection got resolved but in two patient’s early removal of implant was done. And in one patient both hip screws were broken after one month of surgery.

Unstable intertrochanteric fracture continues to be a challenge for orthopaedic surgeons. Despite high union rate, the functional outcome still tends to be disappointing. Intact lateral wall plays a key role in stabilization of unstable trochanteric fracture by providing a lateral buttress for proximal fragment and its deficiency leads to excessive collapse and varus malpositioning. Patients admitted in with unstable intertrochanteric fractures satisfying the inclusion criteria will be included in the study and will be alternatively allocated into two groups i.e. Group A (will contain patients treated with proximal femoral nail without any augmentation,) Group B (will contain patient treated with proximal femoral nail augmented with additional screw or encerclage wire). In our study, in augmentation group According to Harris Hip scoring system (Modified), excellent results are seen in 10(66.7%), we had good results in 1(7.7%), Fair in 4(26.7%) and no case with poor results. Our results are comparable with other studies.
In our study in Control group According to Modified Harris Hip Score excellent result are seen in 6(40%), we had good result in 7(46.7%), Fair in 2(13.3%) and no case with poor results.

Increased life expectancy has led to a considerably increased incidence of proximal femoral
fractures. The standard of peritrochanteric fracture treatment is stable fixation, which allows
early full weight-bearing mobilization of the patient. A prospective, observational and
randomized study was carried out with a total of thirty patients with intertrochanteric femur
fractures admitted in Govt. Medical College and Rajindra Hospital Patiala after fulfilling the
inclusion criteria and were treated with osteosynthesis with proximal femoral nailing antirotation-
2 (PFNA-2) and proximal femoral nailing (PFN) after dividing them into two groups
randomly i.e. Group A and Group B with 15 cases in each. Harris Hip Score was used as criteria
for evaluation of results and functional outcome was graded accordingly. The authors conclude
that PFNA2 gives better results than PFN in intertrochanteric fractures in terms of the amount of
blood loss during surgery, duration of surgery, postoperative complications. However, there is no
difference between the two modalities in terms of duration of hospitalization, fracture union, and
early rehabilitation (mortality and morbidity).

Introduction: Fractures of the proximal femur including the intertrochanteric and subtrochanteric region which are commonly encountered in Orthopaedics especially in elderly population having porotic and weak bones. In elderly these occur even with minimal or trivial trauma ,whereas in the younger population these result from high velocity trauma. These injuries are in association with a high incidence of mortality and morbidity. These injuries were treated conservatively prior to the early 1970’s and are now treated totally surgically now. The goal of any treatment in fracture is stable fixation, 
ultimately leading to early mobilization and decreased incidence of morbidity and mortality. Many surgical interventions like Gamma Nail, Jewet Nail, Condylar plates had been tried but the outcomes were not very satisfactory, so we conducted a study to determine the clinical and radiological outcome in treating such fractures with PFN.
Aim of the Study: Clinical And Radiological Outcome Analysis of Proximal Fractures of femur when Treated with Proximal Femoral Nail
Materials and Methods: A prospective study done in the Department of Orthopaedics at Jawaharlal Nehru Medical College And Acharya Vinoba Bhave Rural Hospital , Datta Meghe Institute Of Medical Sciences ,Sawangi. Patients with Proximal femoral fractures managed with PFN and subsequent follow up at regular intervals for a duration of 1 year.
ExpectedResults:The functional assessment shall be done on the basis of Modified Harris Hip scoring, and at subsequent followed up radiologically with serial X-rays.
These patients with proximal femoral fractures that include intertrochanteric and subtrochanteric fractures, treated with Proximal Femoral Nail are expected to have a shorter incision and subsequently less intraoperative blood loss than the previously used implants. Patients are expected to bear weight earlier.