O1014 USE OF TROCHANTERIC NAIL IN THE SURGICAL MANAGEMENT OF EXTRACAPSULAR FRACTURES OF PROXIMAL FEMUR. A CONSECUTIVE SERIES OF 88 CASES

Abstract

Background: Extracapsular fractures of proximal femur are known to have a significatively high morbidity and mortality rate at one year, and this rate is higher in case of non operative treatment. The standard gamma nail (SGN) was originally designed to provide a stable implant which allows early mobilisation and weight bearing of the elderly patients. The design of SGN however, appeared to be associated with intraoperative or postoperative femoral shaft fractures in up to 17%, requiring further surgery and compromising the outcome in these elderly patients. The trochanteric nail (TGN) was developed to overcome the problems encountered with the use of the SGN.

We report our experience in the use of the TGN in the treatment of extracapsular fractures of proximal femur. Methods: Between December 1999 and January 2001, eighty-seven consecutive patients with an extra-capsular fracture of the femur (in one case bilateral) and one patient with a proximal femoral metastasis were treated with a TGN. Nine patients died within four months of the operation and 3 were lost at follow-up. Seventy-five patients, for a total of 76 fractures were followed clinically and radiographically until the end of treatment, for a mean follow-up period of 10 months. Results: In none of 88 cases did an intraoperative shaft femur fracture occur, nor was this complication observed in the 76 femurs evaluated at follow-up. Postoperative infection was never found and union was achieved in every case. Two cases of cutting-out were reported and both were caused by incorrect placement of implant. Only nine patients (12%) required two crutches or walker at the last follow-up. Conclusion: The TGN is a promising alternative for the treatment of extracapsular fractures of the proximal femur. This implant enables the surgeon to treat most of intertrochanteric and high subtrochanteric fractures with a less invasive technique, and permits early mobilisation and unprotected weight-bearing, without the complications observed with the use of the SGN.