[Osteosynthesis of proximal femoral fractures using short proximal femoral nails].
OBJECTIVE
A group of 147 patients with proximal femoral fractures treated with the use of the proximal femoral nail, manufactured by the Synthes company, in the period between October 1997 and June 2001 were retrospectively evaluated.


METHODS
The group of 147 patients whose average age was 69 years consisted of 59 men (average age, 59 years) and 88 women (average age, 75 years). The most frequent fracture occurring in 54% of the patients was an unstable pertrochanteric fracture (Kyle III); persubtrochanteric and subtrochanteric fractures were treated in 27% and 19% of the patients, respectively.


METHODS
In 1997, a new implant, the proximal femoral nail manufactured by the Synthes company (PFN), was introduced in the Czech Republic. In addition to all advantages of a nail to be implanted intramedullary, it has several other favorable characteristics: its length is 240 mm, pre-drillings is not necessary, it can be dynamically locked, it has a high rotation stability, and mechanical stress concentration on the implant-bone interface is low. This evaluation is based on the type of fracture, the duration of healing, the duration of surgery and X-ray exposure.


RESULTS
The patients were followed up at 6 months, 3, 6 and 12 months, and once a year. The fracture healed in the anatomical position by 6 months in 95% of them. The average operative time was 56 min and X-ray exposure lasted on average 1 min. We recorded 14 intra-operative complications in nine patients, which included incomplete reduction in four cases, fixation in distraction in two, incorrect length of screws in one, fracture at the site of distal locking in two and incorrect insertion of femoral neck screws in five cases. Early post-operative complication involved seven cases of hematoma in the operation wound with the necessity to re-operate in five cases. Late complications occurred in two patients and included pseudoarthrosis and necrosis of the femoral head after healing. Most of the complications were found in subtrochanteric fractures.


CONCLUSIONS
The treatment of unstable fractures of the proximal femur is still associated with some failures. The reasons are: disregard for biomechanics, overestimation of the potentials of new surgical techniques or new implants or poor adherence to established procedures. PFN is a novel, modern implant based on experience with the gamma nail. Since relevant literature data are very few, any comparison of our results is very difficult. The lower average age of our group was due to the intentional selection of our patients for this type of surgery.


CONCLUSIONS
PFN is an excellent implant for the treatment of unstable fractures of the proximal femur. The terms of successful outcome include a good understanding of fracture biomechanics, correct indication and exactly performed osteosynthesis.
Pavelka
T
T
Klinika ortopedie a traumatologie pohybového ústrojí FN Plzen. pavelka@fnplzen.cz
Kortus
J
J
Linhart
M
M
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography