Clinical measurement of femur length as a guide to choose the size of calcar screw (Lag screw) in proximal femur nailing surgery”

Authors: Dr. Gaurav Kumar Singh, Dr Praveen Kumar, Dr. Devendra Singh, Dr. ARUN VAISHY, Dr. GEETIKA KIR

DOI: 10.18231/j.ijos.11197.1759903381

Keywords: PFN,Lag screw, intertrochanteric fracture

Abstract: BACKGROUND: Proximal femur fractures such as intertrochanteric andsubtrochanteric fractures typically occur in elderly patients from low-energy falls fromstanding height, blow to the greater trochanter, or secondary to osteoporosis. Thesefractures in elderly patients are considered severe and have a significant impact onmorbidity and mortality. most of the intertrochanteric and sub-trochanteric fracturesrequire surgery in the form of Internal fixation with intramedullary nailing whichhappens to be one of the treatment modalities for fracture intertrochanteric and subtrochanteric femur. A large proportion of implants supplied by the companies are instandard sizes, Therefore, the purpose of this study was to analyze the femur length ofpatients with extracapsular proximal femur fractures clinically to establish a correlation between the femur length and calcar screw size of the proximal femur nail used in thisfracture fixation. MATERIAL AND METHODS: the study population included 100 patients whounderwent proximal femur nail fixation for intertrochanteric (Boyd & Griffin type 1 andtype 2) and subtrochanteric femur fractures (Seinsheimer type 1 and type 2). Femur length is measured in the uninjured limb clinically in a supine position from the tip of thegreater trochanter to the lateral knee joint line using a measuring tape and recorded incentimeters. Radiographic assessment of the proximal femur was done in the studypopulation in anteroposterior view and lateral view. Using DICOM software,measurement of the tip apex distance is done. RESULTS: The study group included 74 males and 26 females with a mean age of75.97810.94 years and 63.4215.10 years respectively. The mode of injury included 83% fall on the floor and 7% road traffic accident. The fracture pattern involves 85%intertrochanteric and 15% subtrochanteric fractures. shows Significant correlation between the femur length and calcar screw size i.e., correlation coefficient (r) = 0.9128,p < 0.001. CONCLUSION: the purpose of the study was not to suggest concrete screw size for but to offer a general starting point to increase operative efficiency.