Complications Of Treatment Of The Subtrochanteric Fractures Of The Femur By Russell-Taylor Reconstruction Nail

摘要

Thirty cases of closed subtrochantric fractures were treated in adults by Russell –Taylor Reconstruction nail between March 2004 and September 2005. Complications of this modality of treatment are described.Complications were divided into- intraoperative and postoperative complications. Difficulty in the placement of proximal locking screw was the most common complication in the first group followed by difficulty in close reduction of the fracture. Amongst the postoperative complication proximal thigh pain and limb length discrepancy were the main complications. None of these complications, however, contributed adversely to the final outcome of results.The findings of this study revealed that Russell-Taylor Reconstruction nail is the preferred treatment for complex proximal femoral fractures and complications associated are minor and do not significantly contribute towards the final outcome. Moreover these complications decline as the learning curve progresses. Introduction Fractures of the proximal femur and hip are relatively common injuries in adults. The incidence of these injuries is increasing due to the increase in the life expectancy of the population. These fractures are associated with substantial morbidity and mortality, approximately 15-20% of these patients die within one year of fracture 1 .The subtrochantric region extends from the bottom of the lesser trochanter to a point 5 cm more distally; fractures that extend proximally are termed as subtrochantic-intertrochantric fractures 2 . Subtrochantric fractures account for 5-11% of all upper third femoral fractures, and 26.7% of those in the peritrochantric region and have log been recognized as the most difficult to treat 3 .These fractures have traditionally been treated by dynamic extra-medullary implants 4 . The introduction of closed itramedullary nailing of these fractures has addressed many shortcomings of extramedullary static or dynamic fixation. It offers several advantages. The intramedullary location of the implant and its loading sharing property, non opening of the fracture site and thus preservation of the soft tissue envelop, facilitation of healing by the bone graft provided by the intramedullary reaming makes it the treatment of choice in these fractures.Russell-Taylor nailing of subtrochantric fractures is however, technically demanding and is associated with perioperative and post-operative complications. The present article analyses the complications of this procedure in a series of thirty cases. Materials And Methods Thirty cases of closed fractures of subtrochantric region of femur in the age group of 18 and 55 years were operated in the Hospital for Bone and Joint Surgery, Srinagar between March 2004 and September 2005. The average patient age was 37 years. There were 23 male and 7 female patients. Right side was involved in 16 and left in 14 cases respectively. Road traffic accident was the cause of injury in 14[47%] and rest trauma was due to fall from height.Fractures were classified by Seinsheimer’s system. Type III A and IIB were the most common type of fracture pattern.Patients were operated between 2 and 16 days [range, 7.5 days] after trauma. General, spinal or epidural anesthesia was administered for the operative procedure. Operative procedure: The procedure was carried out on a fracture table with both limbs secured to the foot holders. Soft tissue dissection was carried out to identify the entry point in the piriform fossa .A guide wire was placed in to the medullary canal and the canal was reamed to 14 mm in the proximal part and one diameter more in the distal part, to accommodate the nail. Proper size nail was hammered into position. Proximal locking was achieved with the help of the jig whereas the distal locking was done by fee hand technique. Whole procedure was carried out under image intensifier.Touch down weight bearing was allowed as soon as the patient was willing to ambulate. Subsequent progressive weight bearing was