Treatment of stable and unstable intertrochanteric fractures using proximal femoral nail and their functional assessment using modified Harris hip score

Lakshya P. Rathore, Lokesh Gupta, Sanjay Thakur, Sandeep Vaidya, Devender Sharma, Anurag Sharma


Background: Intertrochanteric fracture is common injury and is found in both elderly and the young. Proximal femoral nail (PFN) has been in widespread use for the same in the recent past. There are advocates both for and against this implant. The aim was to study the results of PFN in the treatment of intertrochanteric fractures and their functional evaluation using the modified Harris hip score.

Methods: A prospective study done on 104 patients operated for intertrochanteric fractures with PFN. Patients were followed up at 6 weekly intervals and evaluated at each visit using the modified Harris hip score (HHS).

Results: The study consisted of 104 patients aged from 36 to 96 years with average age of 67.8 years. Most patients belonged to 60-80 years category. Malunion was observed in three patients (2.8%) and non union was not seen in any patient. Excellent to good results were seen in 73% patients 18% patients had a fair outcome, 7.7% had poor and 2% patients had very poor outcome.

Conclusions: PFN is a good implant for intertrochanteric fracture treatment that demands a sound technique and a good reduction prior to insertion. The assessment of results using HHS has been too similar to those obtained using Kyle’s criteria in the previous studies, proving its role in the same.



Intertrochanteric fractures, Proximal femoral nail, Harris hip score

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Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13.

Thomas A. Russell. Intertrochanteric Fractures. Rockwood And Green's Fractures In Adults, 7th Edition. Wolters Kluwer Health; 2004: 1597-1599.

Myderrizi N. Proximal femoral nailing is better choice in treatment of intertrochanteric fracture in elderly people. Int Surg J. 2016;3:781-5.

Koval KJ, Baumgaertner MR, Taksali S. Intertrochanteric Hip Fractures: Intramedullary Hip Screws. Master Techniques in Orthopaedic Surgery: Fractures, 2nd Edition, Philadelphia, United States, Lippincott Williams and Wilkins; 2006: 249-250.

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

Kulkarni GS, Limaye R, Kulkarni M, Kulkarni S. Current concept review Intertrochanteric fractures. Indian J Orthop. 2006;40:16-23.

Anjum MP, Hussain FN, Mehboob I. Treatment of intertrochanteric femoral fractures with a proximal femoral nail (PFN): A short follow up. Nepal Med Coll J. 2009;11:229-31.

Lindsey RW, Teal P, Probe RA, Rhodas D, Davenport S, Schander K, et al. Early experience with a gamma nail for peritrochanteric fractures of the proximal femur. J Orthop Trauma. 1991;71:1649-58.

Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998;80:618-30.

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.

Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2005;16:CD000093.

Murray RC, Frew JF. Trochanteric fractures of the femur; a plea for conservative treatment. J Bone Joint Surg Br. 1949;31B:204-19.

Curtis MJ, Jinnah RH, Wilson V, Cunningham BW. Proximal femoral fractures: A biomechanical study to compare intramedullary and extramedullary fixation. Injury. 1994;25:99-104.

Pavelka T, Houcek P, Linhart M, Matejka J. Osteosynthesis of hip and femoral shaft fractures using the PFN-long. Acta Chir Orthop Traumatol Cech. 2007;74:91-8.

Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg [Br]. 1993;75:789–93.

Endigeri P, Pattanashetty OB, Banapatti DB, Pillai A, Ullas T. Outcome of intertrochanteric fractures treated with proximal femoral nail: A prospective study. J Orthop Traumatol Rehabil. 2015;8:25-9.

Neikar S, Sajjan NY, Telkar NB, Nasequddin S. Clinical research on dynamic hip screw and proximal femoral nail in the treatment of intertrochanteric fractures. J Evid Based Med Healthc. 2017;4(90):5350-4.

Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop. 2001;25:298–301.

Holt G, Nunag P, Duncan K, Gregori A. Outcome after short intramedullary nail fixation of unstable proximal femoral fractures. Acta Orthop Belg. 2010;76:347-55.

Raichandani K, Surana R, Bhardwaj A, Garhwal S, Jain H, Raichandani S. Treatment of Stable and Unstable Intertrochanteric Fracture with Short Proximal Femoral Nail: Our Experience with 100 Patients. Int J Med Res Prof. 2017;3(2):111-5.

Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the Gamma nail and the dynamic hip screw. J Bone Joint Surg. 1991;73-B:330-4.

Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury. 1995;26:615-8.

Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Strømsøe K. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998;12:241-8.

Gadegone WM, Salphale YS. Proximal femoral nail: an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2007;31:403–8.

Strauss EJ, Kummer FJ, Koval KJ, Egol KA. The “Z-effect” phenomenon defined: a laboratory study. J Orthop Res. 2007;25:1568-73.

Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop. 2001;25:298–301.

Gadegone WM, Salphale YS. Proximal femoral nail – An analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2007;31:403-8.

Tyllianakis M, Panagopoulos A, Papadopoulos A, Papasimos S, Mousafiris K. Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): long term results in 45 patients. Acta Orthop Belg. 2004;70:444–54.

Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25:360-2.

Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop. 2001;25:298-301.

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

Schatzker J, Tile M. Subcapital and intertrochanteric fractures. The rationale of operative fracture care (IInd ed) Springer: Berlin; 1996: 340.

Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures-a randomized prospective in the elder patients. J Bone Joint Surg Br. 1992;74(3):345-51.