Result of Subtrochanteric Femoral Fractures Fixation by Proximal Femoral Nail

Subtrochanteric femoral fractures account about 10.0% to 34.0% of all hip fractures with a high complication rate. Anatomically the fracture is proximal to adequately control with implants for femoral shaft and distal enough to control with implants used for intertrochanteric fractures. Inherent instability and forces of muscles giving the fracture a tendency to varus collapse. Due to high rate of implant failure; extramedullary and intramedullary implants are not suitable these fractures. Recently Proximal femoral nail (PFN) has been applied in treatment of subtrochanteric fractures. It has an excellent result in respect of union, fewer complications and early rehabilitation. The aim of this study was to assess the rate and time for union of fractures by PFN and determine perioperative parameters. This prospective study was conducted from August 2022 to July 2023 at Mymensingh Medical College Hospital through non randomized purposive sampling. Total 20 patients aged above 18 years irrespective of sex with closed subtrochanteric fracture were included but pathological fractures, multiple injuries were excluded from the study. Healing process and postoperative complications were recorded after clinical and radiological evaluation. Radiographic Union Score for Tibial (RUST) fracture of Whelan was used to evaluate Union status; by where radiographs (X-ray) based assessment of healing of the four cortices done. The entity cortical scores were added to give an entire score; 4 being the least amount demonstrating fracture are positively not healed and 12 being the highest score representing that the fracture is positively healed. Mean age of the patients was 44.65±12.30 years with range 25-70 years. Majority of patients were male (65.0%) and most of injury (80.0%) due to road traffic accident with most fractures was Seinsheimer type II (45.0%). Average operative time was 98.75±17.23 minutes. Follow up period was average 34.05±3.12 weeks (26-36 weeks) time to union was 13.40±3.80 weeks (10-26 weeks). According to RUST criteria; union rate 95.0% with delayed union 5.0% and no nonunion. There were two patients with superficial wound infection and no implant failure. This study concludes that PFN is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.