Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient with Co-Morbid Condition

Abstract

Background: Intertrochanteric Femur fracture is common in elderly patient with co-morbidity. There was a concept introduced for the biological fixation of intertrochanteric femur fractures by combined use of enders nailing and cannulated compression screws which provides additional rotational stability The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Aims and Objectives: We conducted a study to evaluate the functional outcomes of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures. Study Design: This is a prospective observational type of study. Place and Duration of Study: Department of Orthopaedics, NHL medical college between January 2015 to June 2018. Methodology: 52 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2015 to june 2018. Elderly comorbid patients with osteoporosis and those which require stable fixation with less operative time and minimally invasive procedure were included in this study, Three Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head. Results: All the fractures showed radiological within 13 weeks. The functional assessment was done with modified Harris hip score (Tables 1, 2) and the mean was 86.3±3.41, 26 patients were excellent, 20 patients were good, 4 patients were fair and two patients were poor with respect to total score. The analysis of this study fulfils the objectives of good functional outcome. Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.