Treatment results and complications after PFN osteosynthesis

Hohendorff, B.; Meyer, P.; Menezes, Daniel F. A. de; Meier, Lisa; Elke, R.

doi:10.1007/s00113-005-0962-8

Cited by 58 publications

(32 citation statements)

References 14 publications

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“…Although there is a wide range in the results given for ''quality of operative treatment'' between these studies (4.6-39%), it is noteworthy that comparable definition of this ''quality'' yields nearly identical figures: 20.7% in our study versus 20.8% in the study of Hohendorff et al [14] This does not release ourselves from the obligation to self-critically analyze and improve our operative results. It shows, however, that the technical problems described are commonly encountered and need to be taken into consideration when applying the PFN Ò .…”

Section: Discussionmentioning

confidence: 42%

“…In 10 of these 47 cases, mechanical complications occurred. Hohendorff et al [14] analyzed results and complications of 139 PFN Ò osteosyntheses retrospectively and found a 31.7% complication rate. Their total complication rate was higher mainly because nonmechanical complications like for example hematoma and heart failure were included.…”

Section: Discussionmentioning

confidence: 99%

“…Nuber et al [16] found an ''unsatisfactory result'' on the first postoperative X-ray in 8 of 65 PFN Ò osteosyntheses. Hohendorff et al [14] used various measurements on postoperative X-ray to assess quality of operative treatment. Criteria comparable to ours were varus position of the femoral neck, failure to realign Adam's arc and positioning of femoral neck screw too far cranially.…”

Section: Discussionmentioning

confidence: 99%

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Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients

Appelt

Suhm

Baier

et al. 2007

Eur J Trauma Emerg Surg

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Secondary dislocation, non-union, re-fracture and implant failure are generally known complications after intramedullary fixation of proximal femur fractures with the PFN(®) (Synthes GmbH, Solothurn, Switzerland). The goal of our study was to assess the impact of patient- and treatment-specific risk factors on these complications. Complex fracture type and poor bone quality were defined as patient-specific risk factors. Inadequate fracture reduction and implant position were defined as treatment-specific risk factors. One hundred and seventy-eight cases were retrospectively analyzed. All patients had at least one clinical and radiological follow-up examination 3-6 months after the operation. Fifty percent of the patients were available for one more follow-up at least 1 year after the operation. All patients without patient-specific risk factors had a good outcome, irrespective of whether treatmentspecific risk factors were present or absent. In 153 of the 178 cases, patients had a complex type of fracture and/or poor bone quality. Of these patients, 27 (15.2%) had a poor result. Twenty-four of these patients needed re-operation within 6 months. Complication rate in these patients highly depended on treatment-specific risk factors. We conclude that the PFN is a secure implant for the stabilization of simple cases. Stabilization of complex proximal femoral fractures with the PFN, however, has a relevant complication rate and should therefore be considered a challenge.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients

Appelt

Suhm

Baier

et al. 2007

Eur J Trauma Emerg Surg

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“…In patients with no general complications, the 3-month mortality rate was 2.4%. If a patient had two complications, the 3-month mortality rate increased to 32% to 8% of cut-outs were reported [1,14,[23][24][25]. Five patients (1.2%) experienced lateral blade slide with irritation of the tractus iliotibialis.…”

Section: Discussionmentioning

confidence: 99%

“…Higher revision rates after PFN-osteosynthesis are reported. These range from 7.1 up to 27.3% [1,14]. The frequency of femur shaft fractures following gamma nail treatment is recorded at 2.9-5.6% by various authors [2,3,7,8].…”

Section: Discussionmentioning

confidence: 99%

The Gliding Nail, a Universal Implant in the Treatment of Proximal Femur Fractures

Gehr

Arnold²,

Hilsenbeck³

et al. 2006

Eur J Trauma

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Introduction: Due to the increase in the incidence of osteoporosis with age and the high biochemical load on the proximal femur, the pertrochanteric femur fracture is the typical fracture of the elderly. The number of different fracture types and the characteristic features of this patient population places high demands on any universally applicable implant. The rotational instability of the head-neck fragment in the case of a trochanter minor defect, in particular, is a significant factor in the care of pertrochanteric femur factures. The object of this study was to show that the gliding nail constitutes a universal implant for the care of proximal femur fractures with constantly maintained stability under load. Material and Methods: Between March 1996 and April 2001, 501 patients with per-and subtrochanteric fractures and an average age of 76 were included in the study. All osteosyntheses were carried out using the gliding nail which has an I-beam cross-section profile blade. 73.2% were treated operatively for closed isolated per-or subtrochanteric femur fractures. Results: All patients were restored to full weight-bearing postoperatively. The combined overall early and late complication rate following gliding nail synthesis was only 5.4%. Neither blade cut-out nor head-neck rotation was observed following gliding nail osteosynthesis. Three-month mortality rose from 2.4% in patients with no complications to 90% in patients with four complications. 92.1% of patients were independently mobile at the time of the follow-up examination. Conclusion: With its low complication rate and the ever-present possibility of full weight bearing, the gliding nail fulfills all the requirements of a modern implant for the treatment of proximal femur fractures. In our opinion, its most advantageous features are the high moment of resistance of the I-beam cross-section profile blade which ensures the possibility of gliding, the minimalized risk of proximal cut-out due to the large surface area with two planes of support in the bone, and its secure rotational stability in terms of both nail and bone. The impaction of the blade, which requires no reaming with its resulting loss of bone substance, is responsible for the excellent bone-implant interface.

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Instabile per- /subtrochantere Femurfraktur

Waldherr¹,

Nötzli²

2007

Orthopädisch-Traumatologische Knacknüsse

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Treatment results and complications after PFN osteosynthesis

Cited by 58 publications

References 14 publications

Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients

Complications after Intramedullary Stabilization of Proximal Femur Fractures: a Retrospective Analysis of 178 Patients

The Gliding Nail, a Universal Implant in the Treatment of Proximal Femur Fractures

Instabile per- /subtrochantere Femurfraktur

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