Biomechanically Proximal Femoral Nail (PFN) is a better choice of implant. Still it is associated with screw breakage, cut out through femoral head,”Z” effect, reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of post operative complication and failure rates in unstable trochanteric fracture. Methodology: We did study of 21 unstable trochanteric fractures from Jan 2016 to Nov .2020. 14 patients were males & 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were fixed with 25cm, 1350 PFN mainly 11 mm, 12mm in diameter augmented with one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated fragments or lesser trochanteric fracture. Results: The bone healing was observed in all cases with mean period of 16 weeks. Two patients developed complication of TBW breakage; one developed lateral migration of screws. Patients were followed till # union. At the end of follow up the Salvati and Wilson hip function was 30 (out of 40) in 80% patients. Conclusion: The stabilization of lateral trochanteric wall fracture and communicated fragments with additional one or two TBW increases the stability of construct enhancing bony union & better results.
Adams CI, Robinson CM, Court-Brown CM et al. (2001) Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate of intertrochanteric fractures of the femur. J Orthop Trauma 15, 394–400.
Bendo JA, Weiner LS, Strauss E et al. (1994) Collapse of intertrochanteric hip fractures fixed with sliding screws. Orthop Rev 425, 30–37.
Gupta RK, Sangwan K, Kamboj P, Punia SS, Walecha P (2010) Unstable trochanteric fractures: the role of lateral wall reconstruction. Int Orthop 34(1), 125–129.
Babst R, Renner N, Biedermann M, Rosso R, Hebere M, Harder F, Regazzoni P (1998) Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures. J Orthop Trauma 12, 392–399.
Glassner PJ, Tejwani NC (2011) Failure of proximal femoral locking compression plate: a case series. J Orthop Trauma 25, 76.
Wieser K, Babst R (2010) Fixation failure of the LCP proximal femoral plate 4.5/5.0 in patients with missing posteromedial support in unstable per-, inter-, and subtrochanteric fractures of the proximal femur. Arch Orthop Trauma Surg 130, 1281–1287.
Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 90, 700–707.
Chou DT, Taylor AM, Boulton C, Moran CG (2012) Reverse oblique intertrochanteric femoral fractures treated with the intramedullary hip screw (IMHS). Injury 43(6), 817–821.
Gadegone WM, Salphale YS (2007) Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop 31(3), 403–408.
Gadegone WM, Salphale YS (2010) Short proximal femoral nail fixation for trochanteric fractures. J Orthop Surg (Hong Kong) 18, 39–44.
Megas P, Kaisidis A, Zouboulis P, Papas M, Panagopoulos A, Lambiris E (2005) Comparative study of the treatment of pertrochanteric fractures–trochanteric gamma nail vs. proximal femoral nail. Z Orthop Ihre Grenzgeb 143, 252–257.
Salvati EA, Wilson PD (1973) Long-term results of femoral head replacement. J Bone Joint Surg Am 55A, 516–524.
Kyle RF, Gustilo RB, Premer RF (1979) Analysis of six hundred and twenty-two intertrochanteric hip fractures: a retrospective and prospective study. J Bone Joint Surg 61A, 216–221.
Jones HW, Johnston P, Parker M (2006) Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3279 fractures. Int Orthop 30(2), 69–78.
Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, Pappadas I (2012) Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures – a review. Injury 43(6), 686–693.
Tyllianakis M, Panagopoulos A, Papadopoulos A, Papasmos S, Mousafiris K (2004) Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): long term results in 45 patients. Acta Orthop Belg 70, 444–454.
Rethnam U, Cordell-Smith J, Kumar TM, Simha A (2007) Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications and outcomes: a retrospective analysis. J Trauma Manag Outcomes 1(7), 1–7.
Clawson DP, Melcher PJ (1975) Fractures and dislocation of the hip, in Fractures. Rockwood CA, Green DP, Editors Philadelphia, JB, Lippincott Company, pp. 1012–1074.
Gotfried Y (2004) The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res 425, 82–86.
Palm H, Jacobsen S, Sonne-Holm S (2007) Hip fracture study group. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am 89(3), 470–475.
Sehat K, Baker RP, Pattison G, Price R, Harries WJ, Chesser TJ (2005) The use of long gamma nail in proximal femoral fractures. Injury 36(11), 1350–1354.
Saarenpää I, Heikkinen T, Ristiniemi J, Hyvönen P, Leppilahti J, Jalovaara P (2009) Functional comparison of the dynamic hip Screw and gamma locking nail in trochanteric hip fractures: a matched pair study of 268 patients. Int Orthop 33(1), 255–260.
Fogagnolo F, Kfuri M Jr, Paccola C (2004) Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg 124, 31–37.
Uzun M, Erturer E, Ozturk I, Akman S, Seckin F, Ozcelik IB (2009) Long term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc 43(6), 457–463.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2021 Dr. Vijay Patil, Dr. Pandurang Daule, Dr. Deepak Naikwade