Anyone got an experience of managing bilateral simultaneous pertrochanteric fractures.
Challenging case, for sure.
I would prefer to fix the left femur with Femoral Recon nail (from Synthes or its competitors- whichever is your preference) and right femur with a PFNA (or similar IM device). Patella should be straightforward TBW.
Long PFN both sides and patella tbw. Proximal screw might be problematic as entry site is fractured and proximal femur LCP might also be an option as per intr-op decision.
I did A2FN on right side and a reversed distal femoral locking plate on the right side. TBW for the patella.
Here are the post-op X-rays. The pt. was discharged on 10th post op day from the hospital in a good condition.
Right side is quite nicely done. Presuming that you used a steel nail with those 6.5 mm screws.
Left side reduction is not acceptable. Too much varus and inadequate fixation too. Will be a miracle if this improvisation works. Proximal femoral locking plate (available from Smith & Nephew) would have done the job quite nicely if plating was your preference, though my personal preference if for IM device (as posted in previous post).
Please do let the forum know about the follow up.
Thank you, Narinder. I know the right side is in varus. But there was no option available other than a reversed LCP. Interlocking nail (A2FN and PFN) were not possible due to severe complex and comminuted fracture of the trochanter. PFLC might have worked in a similar manner as a reversed LCP. In fact, a reversed LCP gives multiple hole options to use for fixation of such a complex fracture. Its utility in such bailout situations has recently been documented in several publications.
Very interesting and challenging case, Dr. Vaishya! Would you mind sharing the cause of such injury? Much thanks!
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