Evaluation of unstable trochanteric fractures treated with natural nail and proximal femoral nail: A prospective comparative study

Introduction: Unstable trochanteric fractures are challenging to treat compared to stable types because of a high complication rate. Most of these fractures were treated by a sliding hip-screw system and cephalomedullary nails. Cepahalomedullary nails have a specific advantage over dynamic screw with regard to union rates and complications. The natural nail is a special type of cephalomedullary nail which provides good compression at the fracture site intraoperatively. It has good functional and radiological results compared to conventional proximal femoral nailing.

Materials and Methods: This study was undertaken in patients who were operated between 1^st January 2015 to 28^th February 2017 at M S Ramaiah Hospital, which is a tertiary care hospital in Bangalore. The study included 62 patients with unstable trochanter fracture treated by cephalomedullary nailing. Forty-two cases were fixed with Zimmer natural nail whereas in 22 cases conventional proximal femoral nail was used. Both groups were followed at 6 weeks, 3, 6 months. At each follow up radiological and clinical assessment was done by RUSH score and mobility score.

Results: This prospective comparative study showed several advantages of the natural nail over conventional proximal femoral nails. The average surgery duration with natural n group was 56.55 ± 8.33 and with a proximal femoral nail, the group was 108.41 ± 15.1. Post-operative mobilization and fracture union was early in natural nail group. Complications like screw cutout delayed union and infection was more with proximal femoral nailing group.

Conclusion: Natural nail is better than conventional proximal femoral nails as the average duration of surgery, blood loss and hospital was significantly less. Radiological results and functional results were better for natural nail group and were statistically significant. Short and long term complications are very less with the natural nail.