Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

Abstract

Purpose. To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures. Methods. 17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. Results. 90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments. Conclusion. A PFN is useful for the treatment of trochanteric femoral fractures.

Analysis of outcome of unstable intertrochanteric fractures treated by proximal femoral nail- A prospective and retrospective study

“…In one of our patients though the fracture had united, we could see the 'Z effect' with the migration of hip pins into the joint in which case the nail was explanted. The complication rates in our study were comparable with the other studies [13][14][15] . (figure 7) Incomplete reduction 4 -------# at distal lock 2 -------Fixed in distraction 2 1 -----1 Incorrect neck screw 2 1 -----1 Implant cutout --4 4 ---1 Delayed union --1 -2 --3 AVN / NU ---1 -2 -2 Difficult distal lock ---4 4 --4 Fixed in varus ----3 -2 3 Screw backout ----1 5 2 2 Metin Uzun et al [16] , in 2009, In a study of 35 patients reported Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results.…”

Study of clinical and functional outcomes of unstable intertrochanteric femur fractures treated with long proximal femoral nail

“…Non operative treatment has been found to have a high rate of malunion except in a few studies. Morbidity and mortality associated with conservative treatment, because of prolonged bed ridden state, has been quite high [2] . The last four decades has seen improvement in the management of this common injury, mainly by early surgical fixation and stability of the fracture site.…”

Comparative study between trochanteric fixation nailing and cemented bipolar hemiarthroplasty for the treatment of unstable osteoporotic intertrochanteric neck femur fractures in elderly patients

“…It acts as a buttress to prevent medialisation of the shaft and provides more efficient load transfer. 13 It is designed to provide linear intraoperative compression of head neck segment to shaft along with rotational stability which minimizes neck malunions resulting in negligible complication rate. 14 It also reduces stress concentration at the tip and the smaller distal diameter may prevent femoral shaft fractures.…”