DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20173673

Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures

B. L. Chopra, Krishan Kumar, B. L. Khajotia, Ravindra Bhambu, Sunil Bhatiwal, Vikrant Shekhawat

Abstract


Background: Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.

Methods: It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment.

Results: In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 cases) and poor results in 5% cases (6 cases).

Conclusions: It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging.


Keywords


Proximal femoral nail, Intertrochanteric fractures, Subtrochanteric fractures, Proximal femur fracture

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References


LaVelle GD. Fractures and Dislocations of the Hip. In: Canale ST, Beaty JH, editors. Campbell’s operative orthopedics. 11th ed. Philadelphia: Mosby Elsevier publishers; 2008: 3237-3296.

Weinlein JC. Fractures and Dislocations of the Hip: Campbell’s operative orthopedics. 12th ed. Elsevier; 2013: 2725.

Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): A new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30:327–32.

Prins S, Letsch R, BuÈ scher D. Gamma-nagel und Classic-nagel (intramedullaÈ re Stabilisierung) versus DHS (extramedullaÈ re Stabilisierung) bei proximalen Femurfracturen. Hefte Unfallchir. 1996;262:14.

MuellerME, Nazarian S, Koch P, Schatzker J, editors. The com- prehensive classi®cation of fractures of long bones. Heidelberg: Springer-Verlag Berlin; 1990: 120-121.

Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. J Bone Joint Surg. 1991;73:330-4.

Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg 1995;77:1058-64.

Sierra RJ, Cabanela ME. Conversion of failed hip hemi- arthroplasties after femoral neck fractures. Clin Orthop Relat Res. 2002;399:129-39.

Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury. 1989;20:227–31.

Moein CM, Verhofstad MH, Bleys RL, van der Werken C. Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip. Injury. 2005;36:1337–4.

Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;348:87–94.

Euler E, Huber St, Heining S, Schweiberer L. Spannungsoptische Untersuchung unterschiedlicher Stabilisierungsverfahren bei pertrochantaÈ ren Femurfracturen. Hefte Unfallchir. 1996;262:2.

Velasco RU, Comfort TH. Analysis of treatment problems in subtrochantric fractures of the femur. J Trauma. 1978;18(7):513-23.

Babst R, Renner N, Bieder MM, Rosso R, Heberer M, Harder F, Regzzoni P. Clinical results using the trochanteric stabilizing plate: the modular extension of the dynamic hip screw for internal fixation of intertrochanteric fractures. J Orthop Trauma. 1998;12(6):392-99.

Klinger HM, Baums HM, Eckert M, Neugebauer R. A comparative study of unstable per and intertrochanteric femoral fractures with DHS and PFN and TSP. Zentralbl Chir. 2005;130(4):301-6.

Al-yassari G, Langstaff RJ, Jones JW, Al-Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury. 2002;33(5):395-9.

Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br. 2005;87(1):76-81.

Wang WY, Yang TF, Fang Y, Lei MM, Wang GL, Liu L. Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation. Chin J Traumatol. 2010;13(1):37-41.

Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124(1):31-7.

Kamboj P, Siwach RC, Kundu ZS, Sangwan S, Walecha P, Singh R. Results of modified proximal femoral nail in peritrochanteric fractures in adults. Internet J Orthop Surg. 2007;6:2.

Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN. Unfallchirurg. 2002;105:881–5.

Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003;74(1):53-8.

Ekström W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts KA. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma. 2007;21(1):18-25.

Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures? Clin Orthop Relat Res. 2005;439:221-7.

Jiang LS, Shen L, Dai LY. Intra medullary Fixation of subtrochanteric fractures with Long proximal femoral nail or Long Gamma Nail; Technical Notes and Preliminary Results. Ann Acad Med Singapore. 2007;36(10):821-6.