Kumar M, Akshat V, Kanwariya A, Gandhi M
Department of Orthopaedics, Dr SN Medical College and Hospital, Jodhpur, India.
Department of Orthopaedics, Jhalawar Hospital and Medical College, Jhalawar, India.
Malays Orthop J. 2017 Nov;11(3):36-41. doi: 10.5704/MOJ.1711.014.
Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN). This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. Average duration of union was 17.08 weeks (range 13 to 32 weeks), union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. The long PFN is a reliable implant for subtrochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.
股骨转子下骨折仍然是骨科医生面临的最具挑战性的骨折之一。本研究旨在分析使用股骨近端加长髓内钉（PFN）治疗股骨转子下骨折的处理方法及并发症。这是一项对2012年7月至2016年6月在一家三级医疗中心接受股骨近端加长髓内钉治疗的50例股骨转子下骨折患者的前瞻性研究。骨折根据Seinsheimer分类法进行分类。所有患者均采用Harris髋关节评分进行功能评估。平均愈合时间为17.08周（范围为13至32周），92%的病例实现了愈合。68%的病例实现了闭合复位，32%的病例需要切开复位。12%的病例出现了各种术中并发症，26%的病例出现了延迟并发症。86%的病例获得了良好的解剖学结果，14%的结果一般。根据Harris髋关节评分，28%的病例结果优秀，56%的病例结果良好，16%的病例结果一般。股骨近端加长髓内钉是治疗股骨转子下骨折的可靠植入物，骨愈合率高，软组织损伤最小。髓内固定具有生物学和生物力学优势，但手术技术要求较高。
