A Study on Functional outcome of Proximal Femoral Nail in Intertrochanteric Fracture among Agricultural Population using Modified Harris Hip Score

Abstract

Background: Intertrochanteric fractures, being one of the most commonly encountered hip fractures with rise in elderly population unite’s with conservative treatment, but with the risk of complications increasing the mortality and morbidity. Hence, surgical management is advised for early mobilization to reduce such complications of recumbency. Various implants were designed for surgical fixation such as proximal femoral nail, Dynamic Hip Screw, Gamma Nail. In 1996, AO designed PFN as an intramedullary device for unstable intertrochanteric fractures fixation. Implant designs are changing over a period of time such as helical blade PFN, addition of Trochanteric stabilisation plate, Gotfried percutaneous compression plating. The Purpose of this study is to analyse the radiological and functional outcome of intertrochanteric fracture patients surgically managed with PFN in agricultural population.

Materials and Methods: This study was carried out at Dhanalakshmi Srinivasan Medical College & Hospital among agricultural labourers from January 2020 to July 2022. 40 patients of age more than 60 years with intertrochanteric fractures of femur were treated with Proximal Femoral Nail. Radiological outcome and Functional outcome was assessed with Modified Harris Hip Score

Results: In our study, 18 patients (45%) suffered from fracture pattern 31A1, twenty two patients (55%) suffered from 31A2. Average operating time was 90 min. Complications and treatment failure were encountered in 12 (30%) patients. At 1 year of follow up using Modified harris hip Score, we had excellent results in 70% (28) of patients, good results in 10% (4) patients, fair results in 12.5% (5) patients and poor results in 7.5% (3) of patients.

Discussion: Our study indicates that PFN is an effective implants in osteoporotic and unstable trochanteric fractures even in Indian population where the neck diameter is small with narrow bones. complications like shaft fracture at tip of nail, avascular necrosis were not found. Good reduction of the fracture, and optimal positioning and length of the lag screw are crucial to avoid mechanical complication.

 Conclusion: From this study we conclude that PFN still remains one of the implant of choice for intertrochanteric fractures providing Better radiological union & better functional outcome including squatting & sitting cross legged . Most important is to educate patients regarding surgery & postoperative protocol as patients residing in rural areas in developing countries are not educated enough regarding the need for surgical fixation & post-operative rehabilitation.