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Subtrochanteric femur fractures treated with extramedullary or intramedullary fixation at tertiary care centre

Ravish Patel, Hari Menon, Nitin Chaudhari, Vipul Chaudhari.

Abstract
Background: Subtrochanteric fractures account for 1030% of all hip fractures, affecting persons of all ages. Mostly, these fractures are seen in older osteopenic patients after a low-energy fall and younger patients involved in high-energy trauma. Extramedullary as well as intramedullary fixation techniques have been used to fix such fractures.

Objective: To study the clinical outcomes in patients with subtrochanteric femur fractures treated with extramedullary or intramedullary devices for fixation.

Materials and Methods: Prospective study of traumatic subtrochanteric fractures of femur was carried out among 36 patients at department of Orthopaedics, New Civil Hospital, Surat during January 2013 to December 2014. During surgery, reduction was aimed by closed techniques but when required direct or indirect methods were applied as deemed necessary. Reduction of medial wall and calcar buttress were given prime importance. Pre designed and pre tested semi structured questionnaire was used and analysed with MS Excel and SPSS.

Result: Extramedullary fixation among 17 cases and intramedullary fixation among 19 cases were carried out. Mean follow up was 23.9 months (16.527.6 months). Mean age was 42.4 years (1960 years). A mean incision size was 10.3 cm in intramedullary fixation and 21.8 cm in extramedullary group. Average stay in hospital was 15 days (846 days) for intramedullary group and 20.41 (755 days) for extramedullary group.

Conclusion: Intramedullary method of fixation requires smaller exposure (incision size) hence lesser blood loss, shorter operating time and shorter hospital stay than extramedullary method of fixation.

Key words: Subtrochanteric femur fractures, extramedullary, intramedullary, fixation



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