ArticleCureus2023
Parameters Governing the Fate of Fracture Fixation With Proximal Femoral Nailing (PFN) for Intertrochanteric Femur Fractures.
Article in Cureus, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Evaluation of Orthopedic Outcomes of Proximal Femoral Nailing for Intertrochanteric Fractures and Predictive Value of Pre-operative Glycemic Status, Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio: A Prospective Study.Journal of orthopaedic case reports · 2026Article
- Intraoperative Abdominal Penetration of the Lag Screw: A Rare Complication During Proximal Femoral Nail Anti-Rotation Surgery.Clinical case reports · 2026Article
- Design innovation and rationale of the intramedullary implants for treating Intertrochanteric fractures: A review.Journal of clinical orthopaedics and trauma · 2024Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionA high mortality rate is associated with hip fractures in the elderly. This is because their bones are osteoporotic with implants having less hold and there are more co-morbidities associated with the elderly. Osteosynthesis with the proximal femoral nail (PFN) features the advantages of high rotational stability of the head-neck fragment. However, the use of the nail is technically ambitious and is accompanied by some risks of error, which can lead to failure. This study aims to understand the technical difficulties related to PFN and methods to mitigate them and radiological indicators for successful outcomes of PFN.
methodsOur study aims to analyze the radiological parameters as indicators for the successful outcome of intertrochanteric fractures fixed using PFN and also the factors responsible for intraoperative conversion to dynamic hip screw (DHS). This is a prospective, observational study conducted from January 2020 to December 2020, on all the patients with intertrochanteric fractures who were planned to be treated by PFN and consented to be part of the study group at our institute. This study includes 99 cases of intertrochanteric fractures classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen)/Association of the Study of Internal Fixation (ASIF) and Evan's classification systems and followed postoperatively at regular intervals up to one year. Different methods of fracture reduction, intraoperative radiological parameters, and postoperative radiological parameters dictating the fate of PFN along with factors responsible for the intraoperative conversion to DHS were analyzed and discussed.
resultsOut of 99 patients planned for PFN, four were converted to DHS intraoperatively and 15 patients expired within the follow-up period of one year, leaving only 80 patients in the study group. Of them, seven patients (11.4%) had implant-related complications. According to Chang's reduction quality criteria (CRQC), two cases have CRQC 1 (poor reduction), 11 cases have CRQC 2 (acceptable reduction), 39 cases have CRQC 3 (acceptable reduction), and 28 cases have CRQC 4 (excellent reduction).
conclusionsThough PFN is technically challenging, with proper guidelines and technique, it gives excellent results. Most importantly, a nonvarus reduction, proper nail insertion and accurate placement of lag screws are the crucial factors for a successful outcome. Biomechanically stable reduction, by closed, percutaneous, or open means, is the key to treating unstable intertrochanteric fracture successfully.
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