The objective of the present study was to evaluate the efficacy of proximal femoral nail in the management of unstable intertrochanteric fractures of the hip in different age group and to determine the clinical, radiological and functional outcomes at the end of 6 months of follow up.

Methods: This is a prospective study was done in the Department of Orthopedics Kakatiya Medical College and Mahatma Gandhi Hospital, Warangal. The patients with intertrochanteric fractures underwent surgical treatment with the proximal femoral nail with a follow-up period of 12 months. A standard surgical approach was used during the operative procedure Quadriceps physiotherapy: Strengthening exercises, Static quadriceps exercise, and calf pumping are started soon, followed by knee and ankle mobilization on post-op day 1. Sutures were removed on 12th post-Operative day.  Patients were advised to walk non-weight bearing as soon as tolerable depending upon the fracture pattern.

Results: The total number of cases in this study was n=25 of which n= 16(64%) were males and n=9(36%) were females. Boyd and Griffin Classification of intertrochanteric fractures in the study shows type II were found the most common involving n=14 (56%) of the patients followed by type III n=5(20%). The type I were found in n=4(16%) and type IV was found in n=2(8%) The Harris hip score at the end of 6 months revealed excellent scores in 68% of the patients good score in 24%, fair score in 4% and poor score in 4% of the patients.

Conclusion: proximal femoral nail is a good choice in cases of unstable intertrochanteric fractures of femur because it serves a buttress against the lateral translation of the proximal fragments. It also replaces the comminuted lateral wall which is useful in unstable fractures. The implant temporarily compensates for the function of the medial column.

Keywords: Unstable Intertrochanteric Fractures, Proximal Femoral Nail.

1. Evans PJ, Mcgrocy BJ. Fractures of the proximal femur. Hospital Physician. 2002:38:30-38.
2. Bonnaire F, Zenker H, Lill C, Weber AT, Linke B. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int. 2005:16 Supp 2: S93-S102.
3. Gullberg B, Johnell O, Kanis JA. World-wide projection for hip fracture, osteoporosis international 1997; 7(5):407-13.
4. Konal KJ, Cantu R V, Intertrochanteric fractures in Bucloz RN, Heckman Court brown LM, Torenetta IIIP, Mcqueen MM (7th edn) Rockwood & Green fractures in adults (Wolters Kluwer; Lippincott Williams & Wilkins 2010)
5. Saudan, A. Lubbeke, C. Sadowskil, N. Riand, R. Stern, P. Hoffmeyer. Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail? A Randomized Prospectivee Study of 206 Patients Comparing the Dynamic Hip Screw and Proximal Femoral Nail. Journal of Orthopaedic Trauma 2002; 16(6): 386- 93.
6. Pajarinen, J. Lindahl, O. Michelsson, V. Savolainen, E. Hirvensalo, Pertrochanteric Femoral Fractures Treated with a Dynamic Hip Screw or a Proximal Femoral Nail. A Randomized Study Comparing Post-Operative Rehabilitation, Journal of Bone and Joint Surgery 2005 Jan; 87 (1):76-81.
7. Babhulkar Sudhir Management of trochanteric Fractures. Indian Journal of Orthopaedics October 2006; 40(4): 210-18.
8. Morris AH, Zuckerman JD, American Academy of Orthopaedic Surgeons Council of Health Policy and Practice. National Consensus Conference on Improving the Continuum of Care for Patients with Hip Fracture. J Bone Joint Surgery Am 2002; 84: 670–74.
9. Flores LA, Harrington IJ, Heller M. The stability of intertrochanteric fractures treated with a sliding screw-plate. J Bone Joint Surg Br 1990; 72:37–40.
10. Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury 1989; 20:227-
11. I. Adams, C.M. Robinson, C.M. Court-Brown, MM Mcqueen. Prospective Randomized Controlled Trial of an Intramedullary Nail versus Dynamic Screw and Plate for Intertrochanteric Fractures of the Femur, Journal of Orthopaedic Trauma 2001; 15(6): 394-00.
12. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg [Br] 1991; 73:330–34.
13. Hesse B, Gachter A. Complications following the treatment of intertrochanteric fractures with the gamma nail. Arch Orthop Trauma Surg 2004; 124:692-98.
14. Halder The Gamma nail for peritrochanteric femur fractures. J Bone Joint Surg Br 1992; 74:340-44.
15. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop 2001; 25(5): 298–01.
16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end‐result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737–
17. Pajarinen, J. Lindahl, O. Michelsson, V. Savolainen and E. Hirvensalo, Pertrochanteric Femoral Fractures Treated with a Dynamic Hip Screw or a Proximal Femoral Nail. A Randomized Study Comparing Post-Operative Rehabilitation. Journal of Bone and Joint Surgery 2005; 87(1):76-81.
18. Leung KS5 So WS, Sien WY, Hui PW. Gamma nail and dynamic! hip screws for peritrochanteric fractures. J Bone Joint Surg (Br). 1992;
19. Babhulkar Sudhir S. Management of trochanteric Fractures Department of - Orthopaedics, Indira Gandhi Medical College, Nagpur. Indian Journal of Orthopaedics October 2006; 40 (4):210-18.
20. Miedel R, Ponzer S, Tornkvist H, Soderqvist A, Tidermark J. The standard Gamma nail   or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures: A randomized, controlled trial. J Bone Joint Surg Brit 2005; 87: 68-75.
21. Gallangher JC, Melton LJ, Riggs BL et al. Epidemiology of fractures of the proximal femur in Rocester, Minnesota. Clinical Orthop 1980; 150:163-71.
22. Mather Cleveland: A ten-year analysis of intertrochanteric fractures, JBJS 1983;63B,
23. Dean GL, David S-Jason HN. Osteoporotic pertrochateric fractures; Management and concurrent controversies. J Bone Jt Surg 2004; (Am) 72-B:737-52.
24. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br.1949;31B (2):190–203.
25. Heinz T, Vescei V. Complications and errors in use of the gamma nail. Causes and prevention. Chirurgie 1994; 65: 943-52.
26. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail – A randomized stdy comparing post-operative rehabilitation. The Journal of Joint & Bone Surgery (Br) Jan 2005; 87(1): 76-81.
27. Liu XW, Zhang CC, Su JC, Fu QG, Yu BQ, Xu SG. Treatment of trochanteric fractures of elderly with dynamic hip screw and proximal femoral nail (single-center, randomized and prospective research). Chinese Journal of Bone and Joint Injury. Chinese. 2009;24(9):796-97.
28. Simmermacher RKJ, Bosch AM, Van der Werken C. The AO/ASIF – proximal femoral nail: A new device for the treatment of unstable proximal femoral fractures. Injury 1999; 30: 327-32.
29. Schipper IB, Marti RK, van der Werken C. Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature. Injury.2004; 35(2):142- 51.
30. Windoff J, Hollander D A, Hakmi M, Linhart W, Pitfalls & complications in the use of proximal femoral nail Lagenbecks arch Surg 2005; 3901(1) Epub 2004 Apr 15.
31. N. Kiran Kumar, Gaurav Sharma, Kavin Khatri; Treatment of unstable Intertrochanteric Fractures with Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients the Open Orthopaedics Journal 2015; 9: 456-59.

B Vishwanath Naik

Associate Professor, Department of Orthopedics, MGM Hospital Warangal-50600, India