Affiliation:
1. Senior Resident Department of Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand
2. Department of Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand
Abstract
INTRODUCTION: Intertrochanteric fractures constitute a vast majority of geriatric orthopedic trauma having highest postoperative morbidity
and mortality of surgically treated fractures. Use of cephalomedullary nails for treatment of highly unstable intertrochanteric fractures is now more
common as plate xation is associated with higher risk of implant breakage and screw cutout. However, choice of length of these nails remains
surgeon dependent.
AIM: to compare the functional outcome and complications associated with the use of Long and Short PFN for the treatment of unstable
intertrochanteric fractures (AO/OTAtype 31A1 and 31A2) in elderly population.
METHOD: A prospective interventional study comprising of 58 patients distributed in two groups in which one group (n=25) was treated with
long PFN while other group (n=33) was operated with short PFN. Parameters compared between these two groups included demographic data,
intraoperative blood loss and surgical duration as well as analysis of radiological and clinical progression of union and postoperative complications
in the form of hip pain, anterior thigh pain and failure rate. Functional assessment was done using Harris hip score.
RESULT:This study included only AO/OTAtype 31A1 and 31A2 fracture types in elderly patients above 60 years of age. We found no statistically
signicant difference with regard to age, sex as well as fracture type among two groups. Long PFN group had a shorter union time (11.4 weeks) and
was associated with lesser postoperative complication and failure rate as compared to short PFN. Also, functional outcome evaluated using Harris
hip score shown better scores in long PFN group. However, intraoperative blood loss and surgical duration was found to be signicantly lesser in
short PFN group.
CONCLUSION: use of cephalomedullary nails either short or long for xation of unstable intertrochanteric fractures particularly AO/OTA type
31A1 and 31A2 provides good results. However, longer nails should be preferred over short nails as these are associated with less postoperative
complication such as hip pain or anterior thigh pain owing to excessive curvature of femur in Indian population with lesser union time and better
functional outcome as compared to short PFN. Shorter nails may be used in cases of sick and polytrauma patients where shorter operative time with
minimal blood loss is desirable
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