-Introduction: Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.

No abstract

Getting the trajectory of the proximal femoral nail in the right direction is essential to achieve a good result in the technically demanding surgery of proximal femoral fracture. Either an inappropriate starting point or a failure to match the chosen implant's lateral entry angle may cause coronal plane deformity after trochanteric entry nailing. The lateral view is the critical view for localization of the proper starting point. For the right execution of the surgery, getting the trajectoy right is fully under the control of the surgeon and should always be attempted. Keywords PFN, Proximal Femoral Fracture, Unstable Pertrochanteric Fracture, Nail Trajectory BackgroundThe use of proximal femoral nailing in pertrochanteric fractures is increasingly becoming popular due to the superior biomechanics and prevention of varus collapse. Though it is extremely unlikely to reduce the complications in totality, a better understanding in the procedure certainly helps in the achieving better results. External rotation, abduction, and flexion of the proximal fragment in proximal femoral fracture are the obstacles in nailing.We aim to present a technical tip to get the trajectory of the nail right and minimize the surgical time. ProcedureThe operation of a 55 years old male labourer who had sustained an unstable intertrochanteric fracture on the left side was performed on fracture table in supine position under spinal anesthesia. He had no morbidities and was taken up for surgery within 7 hrs from the fall.

No abstract

No abstract