OUTCOME OF UNSTABLE INTERTROCHANTERIC FRACTURE HIP TREATED WITHPROXIMAL FEMORAL NAIL- A PROSPECTIVE STUDY OF 50 CASES.

Background: Hip fracture in elderly patients is a very devastating complication of osteoporosis and has serious complications leading to serious threat to patient?s mobility & social life and sometimes causing death. Aims &Objectives:To report outcome of 50 consecutive patients having unstable intertrochanteric fracture hip treated with a proximal femoral nail (PFN), a recently introduced cephalomedullary nail by AO. Materials &Methods:Total 50 patients sustaining unstable intertrochanteric fractures due to any cause, as classified by AO underwent proximal femoral nailing with a lag screw, and an anti rotational hip Screw during the period of August 2013 to January 2016.The most common fracture type was A2.2 (n=25), followed by A2.3 (n=15) and A3.1 (n=3) and A3.3(n=7) The position of the tip of lag screw within the femoral head was measured from the center of the head in AP and lateral views, intra operatively, post operatively and in follow ups.. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. Results:90% of lag screws were placed in an optimal position(i.e, inferiorly on AP view and centrally in lateral view) . The length of lateral slide leading to telescoping effect of the lag screw in A2.2 fractures was significantly less than that in A3.3 fractures which are highly communited suggesting that free sliding of the lag screw facilitates direct impaction between fragments. Discussion: Compared to laterally placed slide plates, PFN decreases the bending forces upto 25-30% and in comparison with previous intramedullary devices e.g gamma nails, it showed significant less cutout rates due to an additional antirotational hip screw, with more suitable biomechanical properties. Conclusion.A PFN is optimum implant for the treatment of unstable inter trochanteric fracture hip.