title: Expandable Proximal Femoral Nails (EPFNs) in Elderly Patients.
abstract: OBJECTIVE
  The purpose was to study the performance of expandable proximal femoral nails (EPFNs) for the treatment of unstable intertrochanteric fractures in elderly patients.
  
  
  METHODS
  Eighty-four patients were treated with a newly designed EPFN and followed up for one year.
  
  
  RESULTS
  The mean operating time was 50.1 ± 3.2 min and the mean blood loss was 112.3 ± 5.3 ml. Patients were treated with EPFNs of 220 mm (n = 24), 240 mm (n = 59), and 340 mm (n = 1) length. At six months postoperatively, the Harris Hip Score was 74.5 ± 5.3. At the end of follow up, 75% of patients completely recovered their preoperative function and resumed their normal activities. Seven patients died within one year postoperatively. During the operation, one patient experienced proximal femoral diaphyseal slight crack fracture. This crack fracture was treated by using a long EPFN (340 mm). Two patient developed screw cut-outs, which were solved by reoperation. And one developed deep infection resolved favorably by the appropriate antibiotic treatment. Implant failure, deep venous thrombosis, fat embolism, secondary fracture, and nonunion were not encountered.
  
  
  CONCLUSIONS
  In conclusion, the results of the EPFNs were satisfactory in most elderly patients with unstable intertrochanteric fracture. However, during the inflation period, the pressure on the nail must be monitored carefully in order to prevent a crack fracture.
authors.affiliation: Department of Orthopedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Zhang
authors.forename: Yi-Min
authors.initials: YM
authors.lastname: Chai
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies
keywords: elderly; expandable proximal femoral nails; intertrochanteric fracture; operation; osteoporosis; unstable