Is the Proximal Femoral Nail a Suitable Implant for Treatment of All Trochanteric Fractures?

Abstract

We reviewed 155 consecutive patients who were treated with a proximal femoral nail from 1997 to 2001 to determine the rate of implant specific complications. Results were stratified according to fracture type and surgeon experience to determine which problems occurred in these groups. One year postoperative followup was available for 129 of 132 surviving patients (98%). Failure of fixation occurred in three patients (2%), and a femoral shaft fracture occurred in one patient (0.7%). Fixation failures included one cutout, one delayed fracture healing, and one lateral displacement of the antirotation screw. The total reoperation rate was high (12%) mainly because of hardware removals, which occurred in 13 patients (8.6%). Stratification of results showed that hematomas and iliotibial tract irritation occurred more commonly with lesser surgical experience. General complications and intraoperative problems were seen more often with subtrochanteric fractures. Because the high reoperation rate with the proximal femoral nail is a concern, extramedullary devices continue to be the preferred implants for treatment of stable trochanteric fractures. The low rates of femoral shaft fractures and failure of fixation suggest the proximal femoral nail is useful for treatment of unstable trochanteric and subtrochanteric fractures.

Avaliação do emprego da haste femoral curta na fratura trocantérica instável do fêmur

“…Autores são de opinião que a haste PFN ® possibilita a obtenção de excelentes resultados no tratamento da fratura trocantérica instável do fêmur, principalmente quanto à estabilidade propiciada pelo implante, que permite deambulação precoce com melhor reabilitação funcional do paciente idoso e alto índice de consolidação decorrente da preservação do envelope de partes moles em torno da fratura (37)(38)(39)(40) .…”

Minimally invasive dynamic hip screw for intertrochanteric fractures: comparison with conventional method and surgical tips

“…The perceived benefits are a minimally invasive insertion, rapid surgery and better biomechanical stability. [17][18][19][20][21] However in the meta analysis by Parker and Handoll there was no statistical difference in the operative time, blood loss or radiation exposure in analysis of 3500 patients. 4 Infact there were more chances of intra and postoperative fractures, technical complications and reoperation rates associated with the nailing group.…”

Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures – A randomized controlled trial

“…They are reliable and predictable, but the controlled impaction often leads to malunion with varus collapse and femoral neck shortening. 3,11 PFNs were introduced in the 1990's and they were proven to be very effective in the treatment of subtrochanteric and reverse oblique fractures. PFNs were also used for internal fixation of pertrochanteric fractures, but with contradictory results.…”