Augmentation of proximal femoral nail in unstable trochanteric fractures

Abstract

-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.

Trochanteric Buttress Plate Combined with Proximal Femoral Nail for Unstable Intertrochanteric Fractures. [Innovative Technique]

“…In our series complications are less as comparable to the technical and mechanical complications described in literature [8] [14] [22] [24] [25]. Our findings indicate that the use LATERAL PLATE beneficial in restoring anatomy of proximal femur which prevents loosening of screws and helps in union.…”

“…Author believes that improved bony contact between proximal and distal fragments by stabilization of the comminuted lateral wall is likely to improve the chances of union and maintenance of adequate lever arm [8]. However this method is not useful when the trochanter is fragmented.…”

“…Near-anatomical reduction and optimal positioning of implants are of paramount importance for good outcome and reducing the risk of complications [8].…”

Closed reduction and proximal femoral nailing in the management of intertrochanteric fractures: a prospective study

“…Gadegone et al in their study comprising 82 fractures average time for union was 14.2 weeks. 8 Yadkikar et al in their study of 39 cases Average fracture union time was 16 weeks. The mean pre-injury MHHS was 74 (Maximum of which was 91).…”

PFN in trochanteric fractures: Clinico radiological outcome study

“…In a study by Pajarinan et al [8] , they found that fixing the unstable intertrochanteric fractures initially in a slightly valgus position helps in preventing the excessive varus that may occur during initial 6 weeks. In the article published in 2017 SICOT, Wasudeo M. Gadegone et al [9] went one step ahead to find the solution to prevent the implant failure in unstable intertrochanteric fractures by augmenting the fixation by additional Poller screw missing the nail or by using encerclage wire thereby preventing the lateral blow out. But in the critical analysis from the Norwegian Hip fracture register between 2005 to 2010, based on the observation of 7643 operated Type A1simple two part fractures Kjell Matre MD [10] et al concluded that sliding hip screw is better in Type A1 simple two part fractures than intramedullary nails like PFN as the latter is associated with more number of reoperations within 1st postoperative year Good anatomical reduction of the fracture, and proper positioning and length of the lag screw and derotation screws are crucial for the PFN procedure and reported to yield excellent outcomes [11,12] .…”