Prospective study of the functional and radiological outcome of subtrochanteric femur fractures treated by long proximal femoral nailing in lateral decubitus position

Abstract

Background

Subtrochanteric fractures are subject to a variety of deforming forces that pose challenges to achieving an optimal reduction. This study aims to assess and highlight the advantages of treating these fractures with a long proximal femoral nail while in the lateral decubitus position.

Method

This prospective study was carried out on 35 patients in our institute, managed with long proximal femoral nailing in lateral decubitus position. After surgery, the patients underwent functional and radiological evaluations one, three, and six months later.

Results

Patients in the age group of 18–80 were operated on in this study. The mean age was 52.57, with 14 % [20/35] being males and 42.86 % [15/35] being females. 65 % [23/35] patients had a Russell Taylor type 1A fracture, 20 % [7/35] had 1B type, 8.6 % [3/35] had 2A type and 5.7 % [2/35] had 2B type. The average duration of the surgical procedures was 80 min. The average intraoperative blood loss was 105 ml. Intraoperative reduction assessment using the Modified Baumgartner classification showed 60 % [21/35] having a good reduction, 31.5 % [11/35] having an acceptable reduction, and 8.5 % [3/35] having poor reduction. Mean Harris Hip Score at the end of 6 months was 88 with 38.7 % [12/35] having excellent outcome, 41.9 % [13/35] having good outcome, 12.9 % [4/35] having fair outcome, 6.4 % [2/35] having poor outcome. The most common postoperative complication was shortening with 8.5 % [3/35].

Conclusion

The lateral decubitus position when by utilizing a long proximal femoral nail in subtrochanteric fractures has been demonstrated to facilitate easier identification of the entry point and provide easier access for reaming. This also reduced operative time while improving fracture reduction and subsequently radiological and functional outcomes.