[Osteosynthesis of trochanteric fractures using proximal femoral nails]

Presentation of the existing experience in the use of Proximal Femoral Nail Synthes (PFN) in trochanteric fractures.

A prospective study evaluating a group of 41 patients, 12 men and 29 women, average age 68 years (range 21-93 years) operated on between September 1997 and March 2001 by means of PFN. The group comprised 11 unstable peritrochanteric fractures (31-A2), 26 high subtrochanteric fractures (31-A3), 3 low subtrochanteric fractures and 1 pathological fracture.

Monitored were first of all preoperative and post-operative complications and final results.

The average duration of surgery was in the whole group of 41 patients 61 minutes (30-100 minutes), in the group of high subtrochanteris fractures 58 minutes (30-80 minutes). Average X-ray exposure including the time necessary of the reduction of the fracture was 2.9 minutes (1-6 minutes). In the group there occurred 3 complications. In the first case distal fixation of the mail failed. However, the fractures healed with any other complications. The second case was a patient with unstable peritrochanteric fracture when a too short lag screw was inserted to the head during surgery. In spite of this the fracture healed in 3 months, however, the resulting varus deformity caused a 1.5 cm shortening of the limb. In the third case, a female patient with a low subtrochanteric fracture, fragments were left in distraction and a large fragment of medial cortex bearing also lesser trochanter remained significantly displaced. Even after 6 months the fractures did not healed and therefore we performed dynamization of the nail and cancellous bone grafting in the region of the defect of medial cortex. Final results were evaluated in patients with a minimum follow-up of 6 months, i.e. in 22 patients, 9 patients did not come, 8 patients died. Most patients healed in 3 months (in total 20 patients of 28 followed up) but we set the minimum follow-up period of 6 months when we checked 22 patients of 39. Within six months 8 patients died and another 9 patients did not appear for the follow up. There were 17 cases of a high subtrochanteric fracture, 3 cases of unstable peritrochanteric fracture, one case of per-subtrochanteric fracture and one case of a low subtrochanteric fracture. Within 6 months the fracture healed in 21 patients, i.e. in 95% of the followed-up patients, of this in 20 cases (91%) in anatomical position.

In literature we have found only one publication (Simmermacher et al.--Injury 30, 1999) dealing with PFN which presents very good experience with this implant. Our good results were significantly influenced by preceding experience in the use of Gamma nail. In comparison with it PFN represents an implant of the next generation. However, the basic prerequisite of a good result is a perfect mastering of the surgical technique.

PFN is a method of choice in trochanteric fractures, namely in high subtrochanteric fractures (31-A3).