Intramedullary Fixation of Intertrochanteric Fractures with the Proximal Femoral Nail (PFN)

Abstract

Objective:

Minimally invasive internal fixation of interand subtrochanteric fractures allowing early weight bearing. Restoration of shape and early return to function of the lower limb.

Indications:

All inter- and subtrochanteric fractures of AO type 31.A. Femoral neck and intertrochanteric fractures; associated with proximal femoral fractures; in these instances, a longer nail is used.

Contraindications:

Marked ipsilateral coxofemoral osteoarthritis. Open physes.

Surgical Technique:

Reduction of fracture on fracture table. Stab incision. Unreamed intramedullary nailing. Insertion of femoral neck and antirotation screws over guide wires for dynamic fixation of femoral neck/head fragment ensuring stability in rotation. Possibility of dynamic or static locking at diaphyseal level.

Results:

Between January 1, 1996 and March 31, 1999, the described system was used in 231 patients (74.2% women, 25.8 men, average age 78.1 years). 2.1% intraoperative complications: three inadequate reductions, one antirotation screw implanted too deeply, one wrong placement of distal femoral drill hole. 9.5% postoperative complications related to surgery: three avulsions of implant, one femoral fracture, 14 hematomas or seromas, four deep infections. Followup after 12 months in 76.3% of patients: 63.4% personal postoperative assessment, 12.9% information supplied by family physician. Mortality: 17.5%. Impossible to reach: 6.2% of patients. Late complications in 6.2% of followed-up patients: nine migrating antirotation screws, two late infections. Bony consolidation in all patients, no nonunion. Merle d’Aubigné score: 34.2% excellent, 49.3% good, 13.7% satisfactory, 2.7% poor.