thesis

1. THESIS PRESENTATION
BY
Dr. DEVA K
PG in M.S. Orthopaedics
Department of orthopaedics
Government Cuddalore Medical College and Hospital
( Erstwhile RMMCH)
GUIDE: PROF. DR. SENTHILNATHAN
HEAD OF DEPARTMENT
DEPARTMENT OF ORTHOPAEDICS
CUDDALORE MEDICAL COLLEGE

2. TITLE
PROXIMAL FEMORAL NAILING VERSUS
HEMIARTHROPLASTY FOR TROCHANTERIC FRACTURES
OF FEMUR IN ELDERLY PATIENTS-A RANDOMISED
CONTROLLED STUDY

3. AIM & OBJECTIVE
 To compare the functional and clinical outcome of
proximal femoral nailing and hemiarthroplasty in
trochanteric fracture.
 To assess the efficacy among these operative strategies
 To estimate the prevalence of trochanteric fracture among
the elderly age group.

4. Inclusion criteria
 Patients admitted with trochanteric fracture, who were
independently ambulatory before fracture.
 Age group > 60 years of age.

5. Exclusion criteria
 Patients with pathological fracture.
 Patients aged less than 60 years.
 Patients with previous surgical intervention for
trochanteric fracture.
 Patients with existing deformities.

6. INTRODUCTION
Hip fractures are common among the elderly age group, among
them, trochanteric fractures comprise approximately 50% of the hip
fractures and are often caused by a low-energy fall.[1]
Due to increase in the aging society in India, the incidence of this
fracture is also increasing yearly.
In this study, we are comparing two of the most commonly
employed procedure for trochanteric fractures – Proximal femoral
nailing and hemiarthroplasty, which have their own advantages and
disadvantages postoperatively according to various studies.
Therefore for good stability, activity, early recoverability and
development of complications postoperatively, the two procedures will
be compared and assessed.

7. PFN
In the PFN group of patients, Closed Reduction and Internal Fixation
was done with the patient on a traction table with short or standard
length proximal femur nails under fluoroscopic guidance.[2]

8. HEMIARTHROPLASTY
• In the cemented hemiarthroplasty group, the patient was placed
in the lateral position under anaesthesia and the fracture was
exposed via the posterior approach.
• A bipolar prosthesis of appropriate size was fixed with 40 grams of
bone cement (poly methyl-methacrylate).

9. FOLLOW UP
• Done at 3weeks, 6weeks, 6 months and one year in OPD
• During follow up, All the patients who underwent the fixation with
both proximal femoral nailing and hemiarthroplasty method will be
evaluated both clinically with movements and radiologically with x-
rays in order to assess the outcome of our fixation
• Post operatively patients clinical outcome, recovery rate occurrence
of complications and the prognosis for each procedure will be
assessed separately.
(Sitting, standing with support, full weight bearing, walking with
support, walking without support, osteoporosis)

10. REFERENCE
1. Xu H, Liu Y, Sezgin EA, Tarasevičius Š, Christensen R, Raina DB, Tägil M, Lidgren L.
Comparative effectiveness research on proximal femoral nail versus dynamic hip screw
in patients with trochanteric fractures: a systematic review and meta-analysis of
randomized trials. Journal of orthopaedic surgery and research. 2022 Dec;17(1):1-1.
2. Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional
results of unstable intertrochanteric fractures of femur treated with proximal femur nails
and cemented hemiarthroplasty. Journal of clinical orthopaedics and trauma. 2019 Mar
1;10(2):296-301.
3. Özkayın N, Okçu G, Aktuğlu K. Intertrochanteric femur fractures in the elderly treated
with either proximal femur nailing or hemiarthroplasty: a prospective randomised
clinical study. Injury. 2015 Jul 1;46:S3-8.
4. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus
proximal femoral nailing Yakup Ekinci, MD1,2,3,4 , Kaan Gürbüz, MD1,2 , Sab
5. Desteli EE, İmren Y, Erdoğan M, Aydagün Ö. Quality of life following treatment of
trochanteric fractures with proximal femoral nail versus cementless bipolar
hemiarthroplasty in elderly. Clinical and Investigative Medicine. 2015 Apr 8:E63-72.

11. Thank you