TREATMENT OF COMPLEX FRACTURES OF THE PROXIMAL FEMUR WITH ENDOMEDULLARY NAILS

Abstract

We conducted  a  retrospective  study  of  cases of unstable or complex trochanteric fractures, treated  with  LAN  endomedular   nail  implant of  long  Ortofix,  with  double  proximal  axis and converging cephalic screws. In 78 patients operated between January 2015 and September 2018 at the Alcivar Hospital located in Guayaquil, aged 61 to 90 years, with a follow-up of 12 months. All patients started walking in the first 15 days. Consolidation delay was detected in 5 patients and distal locking screw removal was necessary to energize. The average time to consolidation was 11 weeks ranging from 10 to 24. Two groups are compared, one with reduction with positive medial cortical support (PMCS), and  another with negative medial cortical support (NMCS). The average loss of the femoral axis-neck angle groups was 2 and 3 respectively. The shortening of the cuellofue was 1 mm in the PMCS group and 7 mm in the NMCS group. The incidence of postoperative complications and follow-up was 33%. 1 patient (1.2%) died a few days after the procedure due to associated comorbidities. The WOMAC score at the end of the follow-up period (6 and 12 months)  was 62 and 74, respectively. In conclusion we have  that  the  endomedular nail  is  the  best  option  for  treatment  because of its functional characteristics, little  invasive and dynamic, to solve complex fractures of the proximal femur.