title: Augmentation of proximal femoral nail in unstable trochanteric fractures.
abstract: BACKGROUND
  Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures.
  
  
  METHODS
  We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall.
  
  
  RESULTS
  The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients.
  
  
  CONCLUSIONS
  The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.
authors.affiliation: Department of Orthopaedic and Traumatology, Associate Professor of Orthopaedics, GMC, 442402 Chandrapur, Maharashtra, India.
authors.forename: Wasudeo M
authors.initials: WM
authors.lastname: Gadegone
authors.affiliation: Iyer Orthopaedic Centre, 103, Railway Lines, 413001 Solapur, Maharashtra, India.
authors.forename: Bhaskaran
authors.initials: B
authors.lastname: Shivashankar
authors.affiliation: Department of Orthopaedic and Traumatology, Assistant Professor of Orthopaedics, Smt. Kashibai Nawale Medical college, Maharashtra, India.
authors.forename: Vijayanad
authors.initials: V
authors.lastname: Lokhande
authors.affiliation: Department of Orthopaedic and Traumatology, Assistant Professor of Orthopaedics, Smt. Kashibai Nawale Medical college, Maharashtra, India.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Salphale