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Research Journal of Medical Sciences

ISSN: Online 1993-6095
ISSN: Print 1815-9346
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Is Distal Locking of Long PFNA Necessary in Stable Intertrochanteric Fracture of Femur?

Swapna Pran Saikia, Sikhar Jyoti Bhuyan, Kiran Sonowal, Hrishikesh Goswami, Chao Rochek Buragohain, Kartikey Mishra and Nayanmoni Dutta
Page: 83-88 | Received 11 Sep 2023, Published online: 18 Oct 2023

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https://doi.org/10.36478/10.59218/makrjms.2023.12.83.88

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Abstract

Stable intertrochanteric fracture of femur (AO 31‐A1) is an extracapsular fracture with intact posteromedial cortex. Recent trends shift towards use of intramedullary nails over extramedullary devices. Distal locking screw of intramedullary nail, designed to provide axial and rotational stability. Though distal locking is often routinely done, it has certain disadvantages. This study aims to determine whether distal locking is necessary for the treatment of stable intertrochanteric fracture. 42 patients were selected and randomized equally into distal locked and distal unlocked group from August 2020 to August 2021. Patient were assessed on basis of duration of operation, fluoroscopy exposure, intraoperative blood loss and postoperative complications. Outcomes were assessed on basis of Harris Hip score clincally and serial radiographs. Patients were followed up for 12 months. In distal unlocked group there was reduction in duration of operation (42.90±1.497 min versus 63.19±2.343 min, p<0.0001), fluoroscopy exposure time (69.05±1.925 secs versus 79.05±2.176 secs, p = 0.0014) and intra‐operative blood loss (140.0±7.003 mL versus 168.1±5.632 mL, p = 0.0033) compared to distal unlocked group. Union was seen in all 42 cases. 2 cases (1 from each group) had varus collapse. 1 case had breakage of implant. There was no significant advantages in terms of Harris hip score (88.31±5.654 versus 87.00±6.990, p = 0.6465) By abandoning the use of distal locking screw in long PFNA in stable intertrochanteric fracture of femur (AO 31‐A1), there were advantages in terms of reduction in duration of operation, fluoroscopy exposure time and intra‐operative blood loss which was statistically significant. In terms of union, Harris Hip Score and recovery, distal locking or unlocking has no significant influence.

How to cite this article:

Swapna Pran Saikia, Sikhar Jyoti Bhuyan, Kiran Sonowal, Hrishikesh Goswami, Chao Rochek Buragohain, Kartikey Mishra and Nayanmoni Dutta. Is Distal Locking of Long PFNA Necessary in Stable Intertrochanteric Fracture of Femur?.
DOI: https://doi.org/10.36478/10.59218/makrjms.2023.12.83.88
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2023.12.83.88