46/m, RTA 1 day back, hemodynamically stable. no other injury, chest good. no neurovascular deficit, no comorbidities. planning to nail. PFN? or standard femur interlocking will suffice?


did pfn. reduction came reasonably easily, closed. planning to mobilize with toe touch weight bearing from tomorrow. any suggestions regarding post op protocol?

delay full wt wearing till primary callus formation

It's servers oblique subtrochantric fracture with lesser trochanteric attached proximally. I prefer open the fracture and do Intra medullary nailing by retrograde method. Interlocking IM nail is better option option. But PFN is not a good option .but minimum two screw in neck will not allowed flexion of proximally part at the time when iliopsoas

and I am surprised to see the short proximal fragment not in its typical kejriwal attitude (flexion and abduction)

and sorry it's 46/f, she is pretty obese

Standard im nail would do, obese female even after weight bearing it would give good outcome

consider minimal ORIF n IM nailing in this case...fracture should be reduced n held before starting the nailing. A single cerclage wire may provide necessary stability. I don't think closed reduction will be achieved.

Reverse Oblique Fracture: An absolute indication for intramedullary Fixation device (PFN or a gamma nail) Either type is ok. DHS will fail.

pfn preferred

fracture is oblique in proximal part...can cause difficulty in proximal lockin and patient will have to be kept immoblize...in pfn early moblisation may be started

lateral cortex of the proximal femur is intact. you have a long oblique fracture medial to lateral. standard nailing is easier and less expensive.should be no problem locking the nail.

contract to flax the thigh.

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