Short Proximal Femoral Nail Fixation for Trochanteric Fractures

Abstract

Purpose. To review outcomes of 100 patients who underwent short proximal femoral nailing for stable and unstable intertrochanteric fractures. Methods. Records of 62 men and 38 women aged 56 to 83 (mean, 67) years who underwent short proximal femoral nailing for stable peritrochanteric A1 (n=36), unstable peritrochanteric A2 (n=40), and unstable intertrochanteric A3 (n=24) fractures were reviewed. Results. 80 patients achieved anatomic reduction. At the one-year follow-up, 90% of the patients had good or excellent outcomes, and 50% had returned to their pre-injury functional level. One patient with avascular necrosis noted at 20 months and another patient with non-union/pseudarthrosis underwent a revision bipolar arthroplasty. Two patients had a Z effect and one a reverse Z effect. Six patients with osteoporosis had superior migration of the nail with varus collapse. Two patients had cutting out of the screw, but the fractures eventually healed. Ten patients had shortening of <2 cm. Seven patients had lateral thigh discomfort attributed to irritation Short proximal femoral nail fixation for trochanteric fractures Wasudeo M Gadegone, Yogesh S SalphaleDepartment of Orthopaedics and Traumatology, Chandrapur Multispeciality Hospital, Chandrapur, India Address correspondence and reprint requests to: Dr Yogesh S Salphale, "Shushrusha", Opp. Z.P., Chandrapur, 442401, India. E-mail: yogeshsalphale@gmail.com Surgery 2010;18(1):39-44 2010;18(1):39-44 of the protruding screws against the tensor fascia lata, and 5 of them underwent screw removal. None had fractures of the femoral shaft or trochanter or experienced nail breakage. Conclusion. The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora. Journal of Orthopaedic

Comparison of radiological outcome of unstable Intertrochanteric femur fractures in elderly patients treated with Indian and Foreign Cephalomedullary nails

“…Case example of Indian implant with poor outcome (fig-16). According to Gadegone and Salphale [24] in their study of nailing fixation for trochanteric fractures had union in all cases between 15 weeks to 21 weeks, which is comparable to our study (16.41 weeks in Indian and 15.27 weeks in foreign). According to Schipper et al [8] cut-out of the implant was 3 out of 211 PFN (1.42%) and 6 out of 213 Gamma nail (2.81%).…”

Evaluation of the Functional and Clinical Outcome of Intramedullary Osteosynthesis with Gamma Nail in Treatment of Unstable Peritrochanteric Fractures

“…The nail occupies the medullary canal, preventing excessive sliding and medialization of the shaft even in A3 fractures [6]. The short gamma nail is a superior implant for stable and unstable trochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora [7]. It is recommended that subtrochanteric fractures and hip fractures with associated femoral shaft fractures and pathological extra capsular fracture should be treated by intramedullary fixation [8].…”

Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

“…Until recently dynamic hip screw was the implants of choice for management of inter trochanteric femur fractures, but this implant doesn't give satisfactory results in case of unstable fractures. 2,7,[14][15][16][17][18][19][20][21][22] The reason behind the failure is thought to be due to the longer lever arm, which is placed away from the mechanical axis of the body making it a load bearing device instead of a load shearing one. In view of the failure of the DHS system in the form of varus collapse, implant failure and excessive sliding, intra medullary devices like PFN gained popularity due to its load shearing action and the already mentioned biomechanical advantages over the DHS.…”

“…It may also lead to fracture mal union and associated shortening of limb. [13][14][15][16][17] The ideal implant for the surgical management of unstable intertrochanteric femur fractures is still a matter of debate. Until recently dynamic hip screw was the implants of choice for management of inter trochanteric femur fractures, but this implant doesn't give satisfactory results in case of unstable fractures.…”