Proximal Femoral Nail - A Minimally Invasive Method for Stabilization of Pertrochanteric and Subtrochanteric Femoral Fractures

Fractures of the proximal femur are a big challenge in traumatology. Rapid strides in implant and instrumentations in quest of ideal fixation of pertrochanteric and subtrochanteric femoral fractures have made various options available like Fixed-angled nail plate, Screw plates, Angled blade plate, Dynamic Hip Screw etc. The present study aims to study the role of standard PFN as a minimal invasive device in the management of these fractures. A total of 30 cases of closed fractures (18 pertrochanteric and 12 subtrochanteric) of age 18 or above of either sex were evaluated from 2008 to 2009. 72.2% of pertrotrochanteric and 50% of subtrochanteric fractures were of unstable type. Full weight bearing in 73.4% of the cases was possible at 8 weeks postoperatively. The fracture union in 90% of cases was seen in 12 weeks. 96.7% of cases achieved preinjury walking ability at the end of 24 weeks of follow up. The complications encountered were delayed union (2 cases), varus reduction (3 cases), difficult placement of neck screw/hip pin (2cases) and intra articular migration of neck screw was encountered in 1 case. The current study shows that PFN is an evolving approach to treat intertrochanteric and high subtrochanteric femoral fractures in a minimally invasive way and indicates PFN to be a safe and successful method. Varus collapse, difficulty in placement of neck/hip pin screws and intra articular migration of neck /hip pin screw might be the complications in very few cases which can be minimized by minimizing the technical errors while screw insertion.