scholarly journals Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

2021 ◽  
Vol 10 (2) ◽  
pp. 171
Author(s):  
Johannes Gleich ◽  
Carl Neuerburg ◽  
Christoph Linhart ◽  
Alexander Martin Keppler ◽  
Daniel Pfeufer ◽  
...  
Keyword(s):  
Trochanteric Fracture ◽  
Fracture Pattern ◽  
Proximal Femur Fracture ◽  
Surgical Trauma ◽  
Care Hospital ◽  
Trochanteric Fractures ◽  
Lesser Trochanter ◽  
Fracture Patterns ◽  
The Impact

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed. Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

scholarly journals A Novel Method of Management of Unstable Trochanteric Fractures - A Retrospective Study in a Tertiary Care Hospital, Mysore

2021 ◽  
Vol 8 (18) ◽  
pp. 1264-1269
Author(s):  
Praveen Duraisamy ◽  
Vivekanandan Andavar ◽  
Balachanderc Rajendran ◽  
Girish Chandra Rangaswamy
Keyword(s):  
Fracture Healing ◽  
Trochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Implant Failure ◽  
Care Hospital ◽  
Trochanteric Fractures ◽  
Case Record ◽  
Implant Migration ◽  
Hip Screw

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw

scholarly journals Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769270 ◽  
Author(s):  
Etsuo Shoda ◽  
Shimpei Kitada ◽  
Yu Sasaki ◽  
Hitoshi Hirase ◽  
Takahiro Niikura ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Fracture Pattern ◽  
3D Ct ◽  
Trochanteric Fractures ◽  
Greater Trochanter ◽  
Lesser Trochanter ◽  
X Ray ◽  
Ct Classification ◽  
The Relationship

Purpose: Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Methods: Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. Results: In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. Conclusions: It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 600-606 ◽  
Author(s):  
Christine Moore ◽  
Jastej Dhaliwal ◽  
Agnes Tong ◽  
Sarah Eden ◽  
Cindi Wigston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Skin Lesions ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

Influence of the localization of the primary tumor in the survival of patients with metastatic colon-rectal cancer treated with bevacizumab.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 665-665
Author(s):  
Inmaculada Gallego Jimenez ◽  
Amelia Lopez Ladron ◽  
David Morales Pancorbo ◽  
Eva Fernandez Parra ◽  
Maria Rodriguez de la Borbolla ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Primary Tumor ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Left Colon ◽  
Care Hospital ◽  
First Line Therapy ◽  
Colon Rectal Cancer ◽  
The Impact

665 Background: Bevacizumab, a humanized antibody against the molecular target endotelial growth factor VEGF-A, has incorporated to the standard of care of metastatic colon-rectal cancer (mCRC). A recent study has suggested that the left colon localization of the primary tumor may be a factor associated with a poorer survival in individuals treated against mCRC with bevacizumab including chemotherapy. Our objective was to analyze the impact of the localization of the primary tumor on the survival of patients with mCRC treated with bevacizumab. Methods: Prospective cohort study conducted in a tertiary-care hospital in Spain. Twenty-nine consecutive patients with mCRC who started a first-line therapy including bevacizumab were included. Patients were followed up until death, lost to follow-up or the censoring date (31th August, 2013). The primary end-point of the study was death from any cause. Predictors of survival, including the localization of the primary tumor, were assessed. Results: The median (Q1-Q3) age was 59 (52-67) years and 13 (45%) patients were male. Chemotherapy scheme was XELOX in 13 (45%) patients, FOLFOX in 8 (28%), FOLFIRI in 5 (17%), XELIRI in 2 (7%) and capecitabine in 1 (3%) patient. The localization of the primary tumor were distributed as follows: rectum in 6 (21%), sigmoid colon in 9 (31%), left colon in 9 (31%) and right colon in 5 (17%) patients. After a median (Q1-Q3) follow-up of 29 (13-41) months, 19 (66%) patients died. There were no patients lost to the follow-up. The mean (SD) survival in patients with left colon cancer was 25 (8) months whereas it was 47 (7) months in the remaining population (p = 0.1). The low sample size precluded to perform reliable multivariate analyses. Conclusions: Our study suggests that left colon localization of the primary tumor may have a worse prognosis in patients with mCRC treated with bevacizumab. Although no statistically significant differences have been observed, this fact may have been a consequence of the limited power of the analysed sample. Collaborative studies should be perfomed in order to clarify this issue.

Unstable trochanteric Fracture Fixation with P.F.N. augmented by T.B.W.

2021 ◽  
Vol 8 (1) ◽  
pp. 39-42
Author(s):  
Dr. Vijay Patil ◽  
Dr. Pandurang Daule ◽  
Dr. Deepak Naikwade
Keyword(s):  
Femoral Head ◽  
Trochanteric Fracture ◽  
Bony Union ◽  
Age Group ◽  
Lateral Migration ◽  
Trochanteric Fractures ◽  
Screw Breakage ◽  
Hip Function ◽  
The Stability

Biomechanically Proximal Femoral Nail (PFN) is a better choice of implant. Still it is associated with screw breakage, cut out through femoral head,”Z” effect, reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of post operative complication and failure rates in unstable trochanteric fracture. Methodology: We did study of 21 unstable trochanteric fractures from Jan 2016 to Nov .2020. 14 patients were males & 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were fixed with 25cm, 1350 PFN mainly 11 mm, 12mm in diameter augmented with one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated   fragments or lesser trochanteric fracture. Results: The bone healing was observed in all cases with mean period of 16 weeks. Two patients developed complication of TBW breakage; one developed lateral migration of screws. Patients were followed till # union. At the end of follow up the Salvati and Wilson hip function was 30 (out of 40) in 80% patients. Conclusion: The stabilization of lateral trochanteric wall fracture and communicated fragments with additional one or two TBW increases the stability of construct enhancing bony union & better results.

INTRAMEDULLARY PROXIMAL FEMORAL NAILING FOR UNSTABLE PERITROCHANTRIC FRACTURE: A PROSPECTIVE STUDY

2021 ◽  
pp. 79-82
Author(s):  
Arun Kumar C ◽  
Rakesh Kumar B ◽  
Vaibhav Chaurasia ◽  
Venkatachalam K ◽  
Sathish Babu ◽  
...  
Keyword(s):  
Prospective Study ◽  
Wound Infection ◽  
Trochanteric Fracture ◽  
Operation Time ◽  
Fracture Site ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Trochanteric Fractures ◽  
A Prospective Study

Trochanteric fracture id one of the commonest fractures in Orthopaedics and also among the most devastating injuries of the elderly. The incidence of this fracture increases with advancing age. Around 50% of the Peri-trochanteric variant of these fractures, are of the unstable type. PFNA2 deploys a helical blade which provides compressibility and an additional rotation control at the fracture site.The aim of this study is to assess the effectiveness of Intra-medullary xation of unstable peri-trochanteric fractures with inter-locking proximal femoral nail PFNA2, in a prospective study. This study was done in Department of Orthopaedics, Chettinad Hospital and Research institute, Kelambakkam, Chengalpattu district, Tamilnadu and was spread over 4 years from Jan 2017 to December 2020 with minimum follow-up period of 12 months. 66 patients participated in this study. Harris Hip Score was used to assess the functional outcome. The Harris Hip Score, mean at 6 months was 75.35, which improved to 82.02 by 12 months of follow-up. With regard to our complications 4 patients had a superior cut out of helical screw, which required re-operation by bipolar hemiarthroplasty of the cemented variant. 9 patients had a varus deformity of 10-12 degrees. Abductor lurch was noted in 11 patients. Supercial-wound infection occurred in 8 patients and deep wound infection, requiring surgical irrigation occurred in 3 patients. In conclusion, PFNA2 has better stability, better rotatory stress shielding, superior compaction at fracture site, less blood loss, shorter operation time, less radiation exposure and better clinico-radiological outcomes. PFNA2 is a good implant choice to tackle the complex problems encountered in displaced unstable trochanteric fractures

scholarly journals Patients With Primary Aldosteronism Respond to Unilateral Adrenalectomy With Long-Term Reduction in Salt Intake

2019 ◽  
Vol 105 (3) ◽  
pp. e484-e493
Author(s):  
Christian Adolf ◽  
Daniel A Heinrich ◽  
Finn Holler ◽  
Benjamin Lechner ◽  
Nina Nirschl ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Aldosteronism ◽  
Sodium Excretion ◽  
Salt Intake ◽  
Urinary Sodium Excretion ◽  
Urinary Sodium ◽  
Care Hospital ◽  
Unilateral Adrenalectomy ◽  
The Impact

Abstract Context High dietary salt intake is known to aggravate arterial hypertension. This effect could be of particular relevance in the setting of primary aldosteronism (PA), which is associated with cardiovascular damage independent of blood pressure levels. The aim of this study was to determine the impact of therapy on salt intake in PA patients. Patients and Methods A total of 148 consecutive PA patients (66 with unilateral and 82 with bilateral PA) from the database of the German Conn’s Registry were included. Salt intake was quantified by 24-hour urinary sodium excretion before and after initiation of PA treatment. Study design Observational longitudinal cohort study. Setting Tertiary care hospital. Results At baseline, unilateral PA patients had a significantly higher urinary sodium excretion than patients with bilateral disease (205 vs 178 mmol/d, P = 0.047). Higher urinary sodium excretion correlated with an increased cardiovascular risk profile including proteinuria, impaired lipid, and glucose metabolism and was associated with higher daily doses of antihypertensive drugs to achieve blood pressure control. In unilateral disease, urinary sodium excretion dropped spontaneously to 176 mmol/d (P = 0.012) 1 year after unilateral adrenalectomy and remained low at 3 years of follow-up (174 mmol/d). In contrast, treatment with mineralocorticoid receptor antagonists (MRA) in bilateral PA patients was not associated with a significant change in urinary sodium excretion at follow-up (179 mmol/d vs 183 mmol/d). Conclusion PA patients consuming a high-salt diet, estimated based on urinary sodium excretion, respond to adrenalectomy with a significant reduction of salt intake, in contrast to MRA treatment.

scholarly journals Functional Outcome And Mortality Assessment Following Proximal Femoral Nailing In Inter Trochanteric Fracture

2020 ◽  
Vol 11 (4) ◽  
pp. 5431-5440
Author(s):  
Prabhakaran A ◽  
Selvakumar Pandiyan ◽  
Pradeepkumar T ◽  
Thayumana Sundaram G ◽  
Dharav Parikh ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mortality Rate ◽  
Functional Outcome ◽  
Trochanteric Fracture ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Artery Disease ◽  
Proximal Femoral Nailing

Intertrochanteric fractures constitute one of the most typical fractures of the hip. The incidence of fractures in the trochanteric area has risen with an increase in numbers of the older person with osteoporosis. Mortality, morbidity ratios are increasing in patients with inter-trochanteric fractures. Advanced age and associated co-morbidities are two primary added source for high mortality in trochanteric fracture patients. We conducted this study to assess the mortality rate and the functional outcome in inter-trochanteric fractures after proximal femoral nailing. This is a prospective study, in which 60 Intertrochanteric fractures of femur patients who came to our hospital EMS. Inclusion and Exclusion criteria were included in this study and were done from a period from January 2014 to July 2017. They were evaluated on each follow-up clinically using Harris Hip score and radio-logically using RUST score. The overall mortality rate at the end of the 3-year follow-up in our study is 13.3%. The factor which significantly influenced the mortality rate was Coronary artery disease. Four patients had implant-related complications. One patient developed non-union, which was later revised with Bipolar Hemi-arthroplasty. One patient developed screw back out, and two patients developed screw breakage. Results of our study concluded that elderly patients of age group 75-89 years of age were at higher risk for intertrochanteric fractures. Associated comorbid condition plays a significant role in the mortality of this fractures. In our study, coronary artery disease had a significant influence on the mortality rate for intertrochanteric fractures with a 4.63 fold rise in the mortality rate for these patients.

scholarly journals Impact of a National Lockdown for COVID-19 on Morbidity and Mortality Among Children with Sickle Cell Anaemia at a Tertiary Care Hospital in Uganda

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Ruth Namazzi ◽  
Robert Opoka ◽  
Andrea L Conroy ◽  
Dibyadyuti Datta ◽  
Micheal Goings ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
School Closure ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Phone Calls ◽  
The Impact

COVID-19 and its prevention has put considerable strain on health care systems in low and middle-income countries (LMIC). In Uganda, a national lockdown was declared on March 18, 2020, in response to COVID-19 pandemic and concern of spread of cases without aggressive measures to prevent spread. The lockdown consisted of closure of all offices except essential ones, orders to stay at home unless an emergency occurred, school closure, a ban on all meetings of more than 10 people, a ban on public and private transport, closing down of all shops, malls, restaurants, places of worship and other facilities in which group meetings might occur, keeping a distance of at least 2 metres from other people in public places and a 7:00 p.m. to 6:30 a.m. curfew. Hospitals however remained open and operational. We describe the impact of the lockdown in Uganda in response to the COVID-19 pandemic on the morbidity and mortality in children with sickle cell anaemia (SCA) at a tertiary hospital in Uganda. The number of clinic visits for SCA related complications and death were compared in the pre-lockdown (November 2019 to February 2020) and during COVID-19 lockdown periods (March 2020 to June 2020) in children aged 1- 4.99 years enrolled in a SCA research study [Zinc for Infection Prevention in Sickle cell anaemia (NCT03528434)] at Jinja Hospital, Uganda. In the study, children with SCA are asked to return to the hospital for evaluation whenever they are unwell. Follow up phone calls are made to ascertain the wellbeing of the children and identify any who are unable to come to the hospital. During the lockdown, follow up calls continued and facilitation was provided for caregivers to bring any child who was unwell to the hospital for evaluation. A total of 238 children with a mean (standard deviation) age of 2.7(1.1) years were enrolled and were being followed up when the pandemic started. The incidence of hospital sick visits pre-lockdown and during the lockdown period was 7.7 vs 4.0 person-year, (p= &lt;0.0001). Incidence of hospitalization, pain crises, severe anaemia, or malaria were all higher in the pre-lockdown period than during the lockdown period, 2.4 vs.1.0, 1.8 vs. 0.7, 0.7 vs. 0.4, 0.6 vs. 0.2 and per person year respectively (all p values &lt; 0.01). There were no deaths during the lockdown period compared to 1 death in the pre-lockdown period. Less than 1000 cases of COVID-19 were reported nationally in this period, and none of the study children had known COVID-19 infection, though testing capacity for this was limited. In this cohort of children with SCA, hospitalization and morbidity from SCA-related complications and malaria were are significantly lower during a lockdown period for COVID-19 pandemic than before the lockdown. Reduced access to hospital care is unlikely to explain these findings, as sick children still received care at the hospital, and there was no increase in mortality. Reduced interaction with peers because of the lockdown and social distancing, leading to fewer infections that may trigger SCA-complications, may explain the reduced incidence of SCA complications in this population during the COVID-19 lockdown period in Uganda. Disclosures No relevant conflicts of interest to declare.

scholarly journals Study internal fixation of subtrochanteric fracture of femur with dynamic hip screw, dynamic condylar screw and proximal femoral nail-a retro-prospective study

2018 ◽  
Vol 6 (3) ◽  
pp. 1011
Author(s):  
Sandeep Kumar Mishra ◽  
Deepak C. E. ◽  
Kushal Goari ◽  
Shurendra Shukla
Keyword(s):  
High Velocity ◽  
Trochanteric Fracture ◽  
Early Mobilization ◽  
Subtrochanteric Fracture ◽  
Fracture Pattern ◽  
Surgical Trauma ◽  
Union Rate ◽  
Sliding Hip Screw ◽  
Fixation Devices ◽  
Hip Screw

Background: Sub trochanteric fracture is commonly seen in young adult and middle age man by high velocity trauma. Present study was taken up to study fracture fixation by PFN, DHS and DCS and compare their result in view of union rate, complication, functional out come, operative risk and effectiveness of implant. This study helps to decide appropriate implant for sub trochanteric fracture. In literature comparison of these PFN, DHS, DCS commonly used implants are rare and most of the studies are done in western population by using one or two implants.Methods: Study is done clinically, in a retro to prospective manner by comparing 75 (50 cases retro and 25 cases prospectively) cases of either sex above the age of 18years from May 2010 to May 2014. All fractures are classified by Seinsheimer classification system. Fracture is fixed with DHS, PFN or DCS in 25 cases each.Results: Males with an average age group 21-40-year were commonly affected with right femur fracture due to high velocity RTA. Fracture pattern was commonly type IIC as per seinsheimer classification. Mean union rate and clinical outcome for PFN is high.Conclusions: PFN attempts to combine advantage of a sliding hip screw with those of intramedullary fixation devices. Cases treated with PFN nail have shown easier rehabilitation, less blood loos, less surgical trauma, early mobilization, early rate of fracture union when compared to those cases treated with DHS and DCS barrel plate as per observation of our study. With our study PFN has given us encouraging results over conventional DHS and DCS. Hence, we recommend PFN as better implant for fixation of sub-trochanteric fracture.

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