Sixty patients suffering from pertrochanteric fractures ( A1, A2 and A3 Fractures, AO Classification ) were treated by gamma pinpoint ( Asia Pacific ) from 1 January 1993 to 31 December 2000. The pertrochanteric fractures taken for study were fresh fractures which were studied prospectively after taking due accept. subsequently they were subjected to management by da gamma complete operating room in a consecutive fashion over the above mention period. The survey excluded patients with combination of trochanteric fractures and ipsilateral rotating shaft fracture which were treated by farseeing gamma nail and besides those who were lost to follow-up. Patients were seen postoperatively at regular intervals of first month, one-third month, sixth calendar month and then per annum. All the patients were evaluated for peroperative parameters like duration of screening time ( in seconds ), operating time ( in minutes ), blood loss during surgery ( in mililitres ), ease of procedure ; possible intraoperative complications like malreduction/failure of reduction, jam of smash, drill breakage, failed distal engage, iatrogenic fracture shaft femur, fracture displacement. Blood loss during operation included rake loss due to fracture and operative losses. here screening time meant the prison term during which a especial fracture was screened under image intensifier during surgery. In the present study the comfort of mathematical process was categorized as easy, usual and unmanageable. This was strictly a peroperative immanent criterion and the opinion of the manoeuver surgeons was taken into bill to label a surgery as easy, common or unmanageable. postoperatively they were assessed for malunion, delayed union, osteonecrosis of head of femur, osteoarthritic changes at hep, general and local complications and any extra /revision operation required. besides, they were assessed for date out of bed to professorship, state of ambulation, ambulatory status at release, requirement of ambulatory adjunct devices, weight-bearing condition at discharge and distance of hospital stay. radiographic assessment of fault fragment military position, lag screw position, collar conjunction and extent of fracture healing was made. overall consequence was assessed, categorizing the result as Excellent, Good, Fair and Poor as [ per Kyle ‘s criteria 5 ] [ ] .

Operative Procedure

After preoperative assessment affected role was taken on the grip postpone under spinal anesthesia anesthesia. On an average one aged surgeon and two assistant surgeons participated in each operating room. Maintaining traction, closed reduction was achieved by applying flimsy traction in anatomic axis of the limb without any abduction or adduction and slight inner rotation or external rotation depending on implicit in fracture geometry. The proboscis was tilted to the unmoved side to allow access to the trochanteric sphere. The inverse limb was kept in inflection and abduction so as to position C-Arm. Reduction was verified on effigy intensifier television control. The tiptoe of the greater trochanter was identified by palpation and a 5-cm incision extended proximally from it. Care was taken not to extend the incision excessively proximally as this would damage the inferior gluteal nerve. incision was deepened through fascia lata, splitting the kidnapper muscle for approximately 3 cm immediately above the tip off of the greater trochanter, therefore exposing its tip. Leung et al., 4 have modified the concept of ream of da gamma nail ( AP ). They have recommended minimal intramedullary ream. The entrance web site was opened up with a cannulated curved awl and a scout wire passed into the medulla simultaneously achieving decrease at fracture site. An anteversion guide wire was placed to judge the plane of femoral neck anteversion. Reaming was done in 0.5 millimeter increments up to 10-12 millimeter with the avail of flexible reamers. In order to accommodate the proximal end of the smash, the trochanteric region was reamed up to 17 mm regardless of distal diameter chosen. Short gamma nail AP was used in all cases. Nail of choose size was mounted on introducer jig. Nail was then passed manually with rocking motion. The incision was made on the hide overlying the lateral cortex in line with slot in proximal jig for introduction of lag fuck. lateral cerebral cortex was pierced by an awl. A usher wire was passed through steer sleeve across the lateral cerebral cortex into the posteroinferior sector of femoral head under trope intensifier control and an appropriately sized imprison screw was inserted after drill over stave screw guide wire and was introduced deep in the subchondral region in the center of head in antero back tooth and lateral pass plane. distal lock in was done through jig or by free-hand technique under image intensifier television receiver master. Distally both the screws were locked to achieve rotational stability. immediately postoperatively patient was closely observed for vital parameters, soak of dressing and efficiency of suction drain. patient was kept on antibiotics for 10-12 days. Wound inspection was done in case there was postoperative fever, wound discharge and early signs of contagion. On the first postoperative day patients were made to sit up in layer and chest physical therapy was started. active knee flex and electrostatic quadriceps drill was besides started. Toe touch weight-bearing with crutches was encouraged.

All A1 and A2 fracture at the end of first week and A3 fractures at the end of 2nd week were allowed full moon weight-bearing with crutches followed by squatting ( 6-8 weeks ) cross-leg set ( 8-12 weeks ) and full normal bodily process that was permitted by 15-16 weeks.

Out of a entire of 60 patients four were lost to follow-up before one year after wound and were excluded from the study. The remaining 56 patients were followed up for a think of period of 3.2 years ( range 2-4 years ). There were 52men and four women. Trochanteric fractures were classified according to AO classification into A1, A2 and A3 fractures [ ( A1, A2 ( nitrogen = 36 ), A3 ( normality = 20 ) ]. The beggarly age for AI, A2 fractures ( newton = 36 ) was 53 ± 5.66 years, while the entail age for A3 fractures ( nitrogen = 20 ) was 29.7 ± 7.03 years. Out of a entire of 56 patients, 29 suffered from high-energy trauma while 27 suffered from low-energy trauma. It was observed from the study that high-octane trauma was significant statistically ( X2 = 18.19, phosphorus < 0.001 ) in causing of A3 fractures as compared to A1, A2 fractures. All 56 patients of pertrochanteric fractures undergo surgical interposition which resulted in satisfactory result. The bastardly duration of hospital last out was 14 ± 0.72 days. beggarly screen time was 31s ( range 28-39 mho ) [ – ]. Out of a entire of 56 pertrochanteric fractures three were found to be in difficult category [ A2 ( nitrogen = 2 ), A3 ( nitrogen = 1 ) ] while the rest were easy and usual. The bastardly operate time for these fractures was 40 minute ( scope 35-42 minute ). The average blood loss during the surgery was 800 milliliter in A1 fractures and 850 milliliter in A2 and A3 fractures. Regarding postoperative mobilization all patients were shifted from bed to electric chair after one day. In all fractures toe touch weight-bearing was started the first gear postoperative day onwards. Full weight-bearing was started by the end of the first week in A1, A2 patients ( north = 36, 64.5 % ). In A3 patients ( north = 20, 35.6 % ) full weight-bearing was delayed till the end of the second workweek. This decision was taken considering the stability of nail bone manufacture and as per the delicacy of engage surgeons. The constancy of complete bone reconstruct was assessed depending on comminution of posteromedial lens cortex, transposition of deceptiveness of the underlying fractures, the subsequent ability to achieve anatomic or near anatomic reduction and sufficiency of fixation. During peroperative period there was obstruct of nail ( newton = 1, 1.78 % ) and failed distal lock ( n = 1, 1.78 % ). Jamming of collar was corrected by extracting the nail down and passing a complete with lesser diameter. There was no complication like drill breakage, iatrogenic fracture rotating shaft femur or displacement of fracture. postoperatively one affected role ( 1.78 % ) suffered from chest complications, one ( 1.78 % ) from urinary tract contagion and two ( 3.57 % ) from deep venous thrombosis. One affected role ( 1.78 % ) suffered from early wreathe infection. There was one incidence ( 1.78 % ) of superior cutout of interim screw. This was due to technical failure secondary to nonradiolucent proximal jig which led to slenderly buttocks placement of hip screw with a few proximal threads cutting out of articular airfoil. This was corrected by rewrite operation five days late. The patient was taken to the operation dramaturgy and sleep together was taken out. then lag sleep together of appropriate size was inserted. There was varus deformity in one affected role ( 1.78 % ) secondary to inappropriate placement of hep screw. This was not corrected as it was accepted by the affected role. There was no incidence of implant breakage or symptomatic removal of hardware. A1 fractures achieved union by a entail period of six weeks. Fractures in A2 and A3 category took a mean period of eight weeks to unite. The end results were found to be excellent in 46.34 %, Good in 36.58 %, Fair in 14.64 % and Poor in 2.43 % of patients [ ]. There was no statistically significant remainder ( X2 = 5.61 p > 0.05 ) between A1, A2 and A3 fractures in terms of end consequence. At a mean follow-up of 3.2 years, the fractures had healed in all the patients and no farther treatment was required .

Table 3

Excellent Good Fair Poor
A1A2 fractures 14 17 5 0
A3 fractures 12 4 3 1

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Category : Nail Technique

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