Pitfalls and complications in the use of the proximal femoral nail.
OBJECTIVE
Osteosynthesis with the proximal femoral nail (PFN) features the advantages of high rotational stability of the head-neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. However, the use of the nail is technically ambitious and is accompanied by some risks of error, which can lead to failure of the osteosynthesis. In this paper we present the results of a critical analysis of mistakes that were made in our hospital during the introduction period of this implant.


METHODS
We carried out a prospective analysis of the data of 121 consecutive patients who were suffering from trochanteric or subtrochanteric fracture between December 1997 and December 2000 and who had been treated with a PFN.


RESULTS
We identified intraoperative technical difficulties in 23 patients (19.1%). Seven cases showed postoperative local complications that required operative revision on six patients (4.9%). The main reasons for the failure of the operations involved were poor reduction and wrong choice of screws. Following our critical analysis, we were able to avoid those problems.


CONCLUSIONS
When 31A fractures are to be stabilised with a PFN, the precise technical performance of the implantation represents the basic surgical requirement. Already present minor deviations will subsequently cause loosening of the implants and failure of the operation.
Windolf
Joachim
J
Department of Trauma, Hand, and Reconstructive Surgery, Hamburg University School of Medicine, Martinistrasse 52, 20246, Hamburg, Germany. windolf@uke.uni-hamburg.de
Hollander
Dirk A
DA
Hakimi
Mohssen
M
Linhart
Wolfgang
W
D000368:Aged; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011859:Radiography; D016896:Treatment Outcome