Proximal Femoral Nailing: Getting the Trajectory Right

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.

Reduction Aid in Proximal Femoral Fractures: The Thigh Support

“…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 [2]. The lateral view is the critical view for localization of the proper starting point after a well reduced fracture.…”