Original Research Article
Year: 2019 | Month: April-June | Volume: 4 | Issue: 2 | Pages: 76-90
Evaluation of Results of Closed Reduction and Internal Fixation of Intertrochanteric Fracture of Femur with Ender’s Nail and Cannulated Cancellous Screw Fixation in Elderly
Dr. Alok Sobhan Datta1, Dr. Raj Kumar Singh2
1Associate Professor, Department of Orthopaedics, IPGME&R, SSKM Hospitla Kolkata.
2Post Graduate trainee, Department of Orthopaedics, IPGME&R, SSKM Hospitla Kolkata.
Corresponding Author: Dr. Alok Sobhan Datta
ABSTRACT
This study was conducted with the objective to see whether results of combined use of ender’s nail and cannulated cancellous screw will provide best functional recovery in case of intertrochanteric fracture in elderly. In our study 20 elderly patients were selected on random basis from those attended the outpatient department and emergencies during December 2013 to October 2015 having intertrochanteric fracture of less than two week duration, intertrochanteric fracture with subtrochanteric extension, multiple fractures, and associated medical comorbidities that can be controlled before surgery. In our study among 20 patients 75% of the patients were in the age group more than60 years and 25% of the patients were in the age group less than 60 years with mean age of approx. 65 yr. The male: female ratio in our study was 1.86:1 with 65% patients were male and both right and left side were equally involved. 50% had pre-existing comorbidities; of which diabetes and hypertension were most frequently associated comorbidities and low velocity trauma (LVT) were most common (70%) mode of injury. In our study majority (75%) of the fracture were of type 31A2. Fractures with lateral wall comminution i.e. type 31A3 were excluded from inclusion criteria. 45% patients were operated within a week and 55% patients were operated after a week those had associated medical comorbidities. All the patients were counselled and informed consent was taken. All the patients were operated under spinal anaesthesia and aseptic condition. All patients were received preoperative inj. Cefuroxime 1.5 gm. Operative procedure done under image intensifier control with minimum number of exposures and close reduction were done. During intraoperative period no difficulties and complications were occurred and the average intraoperative blood loss was of 42 ml. In the post-operative period antibiotic and analgesic coverage for atleast seven days were given. Hip and knee physiotherapy were started from next post-operative day. All the patients were discharged after assessment of wound at first postoperative dressing. Sutures were removed after two week. Non weight bearing walking with bilaterally axillary crutch were allowed after first dressing i.e. after 48 hrs. In our study the range of follow up period was 6 to 17 month with the mean of 10.55 month. The patients were followed up regularly at 4 weeks interval for the first 6 month and then at 3 months interval. At each follow up patient is assessed clinically, radiological and functionally. Radiological assessment done by digital X- ray of pelvis with both hip AP view and Lateral view of the operated hip with femur. Functional assessment done by modified Harris hip score. In our study all fractures were united with an average period of 13 weeks with range 10-16 weeks, 20% of the patients had accurate anatomical reduction and the neck shaft angle was same as on unaffected side, 65% of the patients had 3 to 5 degree of variations in the neck shaft angle compared to unaffected side, and 15% patients had more than 10 degree of in the neck shaft angle compared to unaffected side. The average neck shaft angle of the fractured hip in the last follow up X-ray was 128.55 degree with the range 115 to 135 degree. The average difference between the neck shaft angle of fractured side and the normal side, in the last follow up X-ray was 4.80 degree. In our study none of the patients had any systemic complications and complications related to local soft tissues). Regarding complications related to fracture and their union, in our study all the fractures were united but two of them united with external rotation deformity and three of them have varus deformity). In this study 50% of the patients had no leg length discrepancy, 45% of the patients had leg length discrepancy less than one cm, and 5% of the patients had leg length discrepancy of 1.5 cm). The functional assessment was done with modified Harris hip score and the mean was 86.3 with the range from 73 to 95 and eight patients were excellent, 10 patients were good and two patients were fair with respect to total score. The analysis of this study fulfils the objectives of a good functional out come.
Key words: internal fixation, intertrochanteric fracture, ender’s nail, cannulated cancellous screw