Pro’s and Con’s of proximal femoral nail in Peri trochanteric fractures

Abstract

Background: Fractures of the trochanteric region of femur can be difficult to treat. This anatomic region experiences the highest tensile and compressive stresses in the human skeleton. The proximal fragment is often quiet short, offering limited opportunity for internal fixation, which must withstand these substantial forces. In subtrochanteric fracture, the proximal fragment is flexed, abducted and externally rotated due to the Iliopsos, abductor muscles, and short external rotators muscle pull. Hence, it is useful to perform an open reduction of the fracture fragments and then stabilise the proximal fragment to restore anatomical position, prior to nail insertion. Methods: The present study consists of 20 adult patients with proximal femoral fractures of femur who were treated with PFN at Bims, Belgaum between Jan 2014 to March 2018. The fractures were classified according to Russell and Taylor classification. 20 cases were followed at regular intervals. This study was conducted with due emphasis for clinical observation and analysis of results after surgical management of peritrochanteric fractures of femur. Results: In our study of peritrochanteric fractures treated with PFN, we encountered intraoperative complications like iatrogenic fracture of lateral cortex in 2 cases (10%) due to selection of wrong entry point, failure to put derotation screw in 2 cases (10%) and guidewire breakage in 1 case (5%). Delayed complications like hip joint stiffness in 3 cases (15%), knee joint stiffness in I case (5%) and shortening of more than one cm in 1 case (5%) and delayed union in 2 cases (10%). Conclusions: Open reduction offer advantage in preventing malalignment of peritrochanteric fractures as compared to closed reduction. From our study we conclude that PFN is a reliable implant for peritrochanteric fractures, leading to high rate of bone union restoring the anatomical alignment and reduced chance of implant failure or deformities.