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Proximal Femoral Nailing: Technical Difficulties and Results in Trochanteric Fractures*

Aithala , Janardhana P and Rao, Sharath (2013) Proximal Femoral Nailing: Technical Difficulties and Results in Trochanteric Fractures*. Open Journal of Orthopedics, 3 (5). pp. 234-242.

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Abstract

Background: Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. However, techni-cal difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues. Our study aims to understand technical difficulties involved in proximal femoral nailing, and spe-cifically analyses neck shaft angle at follow-up indicating varus collapse and also to compare results of stable and un-stable fractures. Materials and Methods: In this study, patients who presented to the Orthopedic Unit of Dr. TMA Pai Hospital (An associated hospital of Manipal University, Manipal) with trochanteric fractures included and treated with proximal femoral nailing. The technical difficulties involved with surgical procedure and techniques adapted to overcome such difficulties were recorded. All patients were followed up for a period of 2 years and final outcome assessment in-cluded the number of shortening, neck shaft angle and harris hip score. Results: 41 patients (mean age 71) who under-went proximal femoral nailing from January 2004 to December 2009 were included in the study, 38 patients completed 2-year follow-up. The technical difficulties we faced were divided into 3 categories, difficulties in securing entry point and guide wire placement especially when greater trochanter and piriform fossa were gathered, reduction was lost while passing nail, and finally difficulties faced during placement of hip screws. In all except one, neck shaft angle of more than 130 degrees was achieved, and this was also maintained in the final follow-up (Mean 131.9 degrees). All fractures were united, with mean shortening of 2 mm. Conclusions: Although PFN is technically required, with a proper tech- nique PFN gives excellent clinical results with almost negligible varus collapse even in unstable trochanteric fractures. Regarding the techniques, reaming the proximal part of femur adequately and observing the nail passage with image carefully are important in placing the nail correctly, while, placement of lag screw in the inferior part of neck in anterior posterior projection and central in lateral projection reduces risk of implant failure.

Item Type: Article
Uncontrolled Keywords: Trochanteric Fractures; Proximal Femoral Nailing; Varus Collapse
Subjects: Medicine > KMC Mangalore > Surgery
Depositing User: KMCMLR User
Date Deposited: 06 Dec 2013 07:16
Last Modified: 06 Dec 2013 07:16
URI: http://eprints.manipal.edu/id/eprint/137914

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