DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150838

Long PFN in unstable subtrochantric fracture with absent lateral wall support in proximal fragment with delayed augmentation with encircalage wire and bone grafting

Sudarshan A. Kamble, Sanjay R. Bharti, Jay Rundan Rathod

Abstract


In 1949 Boyd and Griffin Subtrochanteric fracture femur as a variant of peritrochanteric fracture with higher incidence of unsatisfactory result both in the elderly and young. Most of this fracture is with higher incidence of unsatisfactory result after operative treatment This single case study shows one of the unpredicted iotrogenic complications. Material and method: Patient is 78yr female patient with multiple co-morbid conditions with subtrochanetric fracture. Surgery was done with long PFN nail  inserted with good purchase in head, reduction check under C-arm with  in antero-posterior & lateral  view shows little malreduction and nail  is out of medulary cavity in proximal fragment. Revision in same sitting not possible due to some medical reasons. Revision surgery done after fitness and reduction held with encieclage wire and bone grafting done. Conclusion: Even without lateral wall support if there is good purchase of screws in head and shaft, there will be good union and good functional outcome.


Keywords


Subtrochanteric fracture,Peritrochanteric fracture,Bone grafting

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References


Campbell’s operative orthopaedics volume three, twelfth edition.

Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991;73:330–4.

LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop 2001;25:298–301.

Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury 1999;30:327–32.

Ramakrishnan M, Prasad SS, Parkinson RW, Kaye JC. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail. Injury 2004;35:184–90.

Friedl W, Colombo-Benkmann M, Dockter S, Machens HG, Mieck U. Gamma nail osteosynthesis of per- and subtrochanteric femoral fractures. 4 years experiences and their consequences for further implant development [in German]. Chirurg 1994;65:953–63.

Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective randomized controlled trail. Injury 1995;26:615–8.

Lustenberger A, Ganz R. Epidemiology of trochanteric femoral fractures over 2 decades (1972-1988) [in German].

Behr JT, Dobozi WR, Badrinath K. The treatment of pathologic and impending pathologic fractures of the proximal femur in the elderly. Clin Orthop Relat Res. 1985;198:173–8.

Gainor BJ, Buchert P. Fracture healing in metastatic bone disease. Clin Orthop Relat Res. 1983;178:297–302.

Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)—our first 60 cases. Injury. 2002;33:401–5.

Nazri MY, Halin YA. Outcome of infection following internal fixation of closed fractures. Med J Malaysia. 2004;59:665–9.