Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70-93) and the mean Barthel activity score was 16.21 (range 12-20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.
Getting the trajectory of the proximal femoral nail in the right direction is essential to achieve a good result in the technically demanding surgery of proximal femoral fracture. Either an inappropriate starting point or a failure to match the chosen implant's lateral entry angle may cause coronal plane deformity after trochanteric entry nailing. The lateral view is the critical view for localization of the proper starting point. For the right execution of the surgery, getting the trajectoy right is fully under the control of the surgeon and should always be attempted. Keywords PFN, Proximal Femoral Fracture, Unstable Pertrochanteric Fracture, Nail Trajectory BackgroundThe use of proximal femoral nailing in pertrochanteric fractures is increasingly becoming popular due to the superior biomechanics and prevention of varus collapse. Though it is extremely unlikely to reduce the complications in totality, a better understanding in the procedure certainly helps in the achieving better results. External rotation, abduction, and flexion of the proximal fragment in proximal femoral fracture are the obstacles in nailing.We aim to present a technical tip to get the trajectory of the nail right and minimize the surgical time. ProcedureThe operation of a 55 years old male labourer who had sustained an unstable intertrochanteric fracture on the left side was performed on fracture table in supine position under spinal anesthesia. He had no morbidities and was taken up for surgery within 7 hrs from the fall.
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