Proximal Femur Nail in Intertrochanteric Fractures Indications and Tips/Tricks

Abstract

A. Advanced versions of both nails offer spiral blade instead of head screws, lesser mediolateral angle of 5 degrees, and flat lateral surface at proximal end, long nail options. B. Surgical technique remains the same. C. Features change from manufacture to manufacturer; hence we need to study the design of chosen nail carefully (Table 1). Table 1: Comparison between Proximal femur nail (PFN) and Trochanteric femoral nail /Trochanteric fixation nail (TFN) PFN TFN Length 240 mm. Length 170 mm. Less anterior cortex impingement. Proximal diameter around 17 mm. Smaller proximal diameter around 15 mm. In narrow canals less possibility of impingement/ fracture extension during nail insertion. PFN Biomechanically stronger than DHS A. Intramedullary. Nearer axis of deforming force. B. Resists excessive collapse by buttress effect. C. Replaces comminuted lateral wall. D. Often has 2 Screws in head. Lag screw and hip pin. Controls rotation well (Figures 2 & 3). Factors that Ensure Success in PFN A. Maintaining the proper neck shaft angle. B. Placing the Lag screw (Compression Screw) in the centre of hip (or sight inferior). C. Compression screw first. (inferior lag screw). D. Hip pin should be shorter by at least 15mm.

Comparison between Gamma Nail and Proximal Femoral Nail in Management of Unstable Intertrochanteric Fractures

“…Anesthetic technique was a decision of the anesthetist according to the expected duration of surgery, patient health status and intraoperative conditions according to American Society of Anesthesiology classification (ASA score): 5 Antibiotics: Single dose of third generation cephalosporin was given intravenously for each patient intraoperatively and was continued postoperatively every 12 hours for 7 days. Operative technique: 7 In Gamma nail, it can be done with or without a traction table. Usage of traction table, the lower limb must be adducted to assist nail insertion.…”