Treatment of Unstable Trochanteric / Subtrocanteric Fractures with PFN, First Cases in University Hospital of Trauma & American Hospital. Results and Complications.
AJTES Vol 4; No 1; January 2020
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trochanteric fractures

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Fezollari, L., Caushi, G., Ruci, V., Duni, A., Dogjani, A., Selmani, E., Demiraj, Z., & Bassi, G. (2020). Treatment of Unstable Trochanteric / Subtrocanteric Fractures with PFN, First Cases in University Hospital of Trauma & American Hospital. Results and Complications. Albanian Journal of Trauma and Emergency Surgery, 4(1), 603-621.


Aims and objectives: This study was done to evaluate the functional and radiographic outcome of PFN in treatment of proximal femoral fracture and more common technical, mechanical complications and intraoperative difficulties during the implant implementation.

Materials & 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 classification AO and Boyd-Griffin. 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 month period. In the result, functional clinical assessment according to Harris hip score was done .

Results: In our study,mean age was 66 y.o, 7 male and 3 females. Mean of hospitalization time 6 days, mean operation time 120 min. In our study at 6 months follow up, union was achieved in 9 cases, open reduction was performed in 3 cases (10 cases). Technical and mechanical complications were noted in one case. Reoperation rate was 10 % (one case). According Harris hip scoring system excellent results were seen 40   % of cases (4 cases), good results in 50 % cases (5 cases),  and poor results in 10% cases (1 case).

Conclusions: In our study, in spite of low experience in proximal femoral nailing in cases with unstable trochanteric / subtrocanteric fractures, it was found that PFN is an attractive implant and suitable for proximal femoral fractures and its use in unstable trochanteric / subtrocanteric fractures is very encouraging. This study has also shown that this device can safely be used by an average surgeon to handle common but sometimes tough fractures. Operation is technically not difficult, but gradual learning and great patience is needed to make this method really minimal invasive.
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1. 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. 1999;30:327–32.
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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