Keywords
Proximal femoral nails
treatment
How to Cite
Abstract
Aims and objectives: This study aimed to evaluate the functional and radiographic outcomes of Proximal femoral nails (PFN) in the treatment of proximal femoral fractures, focusing on common technical, mechanical complications, and intraoperative difficulties during implant implementation.
Materials and Methods: We conducted a retrospective study with ten cases of proximal femoral fractures treated between September 2017 and September 2018, which were accepted at the Department of Orthopedics, the University Hospital of Trauma, and the American Hospital in Tirana. Fractures are classified according to the AO and Boyd-Griffin classifications. The age range of patients taking the study was 20-90 years. Ten cases were followed at regular intervals, and the final assessment was made at the end of the 6 months. As a result, functional clinical assessment was done using the Harris hip score, a widely used tool to evaluate the outcomes of hip surgery.
Results: In our study, the mean age was 66 years, with 7 males and 3 females. The mean hospitalization time was 6 days, and the mean operation time was 120 minutes. At the 6-month follow-up, union was achieved in 9 cases, and open reduction was performed in 3 cases (10 cases). Notably, technical and mechanical complications were noted in only one case, demonstrating the overall success of the PFN treatment. The reoperation rate was 10 % (one case). According to Harris's hip scoring system, excellent results were seen in 40% of cases (4 cases), good results in 50% of cases (5 cases), and poor results in 10% of cases (1 case).
Conclusions: Despite limited experience in proximal femoral nailing for unstable trochanteric/subtrochanteric fractures, our study found that Proximal femoral nails are an attractive implant for proximal femoral fractures. Their use in unstable trochanteric/subtrochanteric fractures is particularly encouraging, as they have shown potential in handling even the most challenging fractures. This study has also shown that an average surgeon can safely use this device, making it a promising tool in the field of orthopedics. Operation is technically not complex, but gradual learning and great patience are needed to make this method minimally invasive.
References
2. Rins S, etsch R, Bu scher D. amma-nagel und Classic-nagel intramedulla re Stabilisierung versus DHS (extramedulla re Stabilisierung bei proximalen Femurfracturen. Hefte Unfallchir. 1996;262:14.
3. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury [Internet]. 1999 Jun [cited 2017 Oct 13];30(5):327–32
4. Synthes. PFN – Proximal Femoral Nail. Image (Rochester, NY). 2006;
5. Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)--our first 60 cases. Injury [Internet]. 2002 Jun [cited 2017 Oct 13];33(5):401–5
6. Of AS, Of M, Fracture S, By F, Nailing P, To DS. a Study of Management of Subtrochanteric Fracture Femur By Proximalfemoral Nailing Dissertation Submitted To. 2011;(December):1–85.
7. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. J Bone Joint Surg. 1991;73:330-4.
8. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg 1995;77:1058-64.
9. Sierra RJ, Cabanela ME. Conversion of failed hip hemi- arthroplasties after femoral neck fractures. Clin Orthop Relat Res. 2002;399:129-39.
10. Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury. 1989;20:227–31.
11. Moein CM, Verhofstad MH, Bleys RL, van der Werken C. Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip. Injury. 2005;36:1337–4.
12. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;348:87–94.
13. Euler E, Huber St, Heining S, Schweiberer L. Spannungsoptische Untersuchung unterschiedlicher Stabilisierungsverfahren bei pertrochanta ren Femurfracturen. Hefte Unfallchir. 1996;262:2.
14. Velasco RU, Comfort TH. Analysis of treatment problems in subtrochantric fractures of the femur. J Trauma. 1978;18(7):513-23.
15. Babst R, Renner N, Bieder MM, Rosso R, Heberer M, Harder F, Regzzoni P. Clinical results using the trochanteric stabilizing plate: the modular extension of the dynamic hip screw for internal fixation of intertrochanteric fractures. J Orthop Trauma. 1998;12(6):392-99.
16. Klinger HM, Baums HM, Eckert M, Neugebauer R. A comparative study of unstable per and intertrochanteric femoral fractures with DHS and PFN and TSP. Zentralbl Chir. 2005;130(4):301-6.
17. Al-yassari G, Langstaff RJ, Jones JW, Al-Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury. 2002;33(5):395-9.
18. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br. 2005;87(1):76-81.
19. Wang WY, Yang TF, Fang Y, Lei MM, Wang GL, Liu L. Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation. Chin J Traumatol. 2010;13(1):37-41.
20. Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124(1):31-7.
21. Kamboj P, Siwach RC, Kundu ZS, Sangwan S, Walecha P, Singh R. Results of modified proximal femoral nail in peritrochanteric fractures in adults. Internet J Orthop Surg. 2007;6:2.
22. Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN. Unfallchirurg. 2002;105:881–5.
23. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003;74(1):53-8.
24. Ekström W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts KA. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma. 2007;21(1):18-25.
25. Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures? Clin Orthop Relat Res. 2005;439:221-7.
26. Jiang LS, Shen L, Dai LY. Intra medullary Fixation of subtrochanteric fractures with Long proximal femoral nail or Long Gamma Nail; Technical Notes and Preliminary Results. Ann Acad Med Singapore. 2007;36(10):821-6.
27. Chopra BL, Kumar K, Khajotia BL, Bhambu R, Bhatiwal S, Shekhawat V. Proximal femoral nail- outcome and complications: a prospective study of 125 cases of proximal femoral fractures. Int J Res Orthop 2017;3:973-8.
28. Chakraborty M, Thapa P. Fixation of subtrochanteric fracture of the femur: Our experience. J Clin Diagnostic Res. 2012;6(1):76–80.
29. Hak DJ, Wu H, Dou C, Mauffrey C, Stahel PF. Challenges in Subtrochanteric Femur Fracture Management. Vol. 38, Orthopedics. 2015. p. 498–502.
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