Hip Pelvis.  2012 Dec;24(4):302-308. 10.5371/hp.2012.24.4.302.

Fixation Failure of Proximal Femoral Nail Anti-rotation in Femoral Intertrochanteric Fracture

  • 1Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu, Korea. oslee@dsmc.or.kr


The aim of this study was to identify the causes of fixation failure and evaluate prophylactic methods in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation.
Between 2006 and 2010, this study evaluated 80 cases(20 men and 60 women) of femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation after a minimum follow-up of 1 year. The mean age and follow-up period was 72.6 years and 2.1 years, respectively. The factors that could affect fixation failure, such as osteoporosis, fracture pattern, reduction status and position of helical blade on the femoral head, were analyzed retrospectively.
Six cases of fixation failure were encountered: 4 cases of cut out of the helical blade, 1 case of excessive varus union and 1 case of hip joint pain due to the excessive sliding of helical blade. The reduction status and position of the helical blade on the femoral head showed a significant association with the fixation failure, and there were 2 cases of osteonecrosis of the femoral head at the latest follow-up.
Fixation failure was increased significantly in the case of non-anatomical reduction or superior position of helical blade in the femoral head. Therefore, the concerns related to the precise anatomical reduction and central location of the helical blade will need to be solved to reduce fixation failure.


Femur; Intertrochanteric fracture; Proximal femoral nail anti-rotation; Fixation failure

MeSH Terms

Follow-Up Studies
Hip Fractures
Hip Joint


  • Fig. 1 (A) Immediate postoperative radiographs show anatomical reduction and acceptable position of blade in unstable fracture. (B) Radiographs obtained at 18 months after surgery show stable fixation of implant and firm union of fracture site.

  • Fig. 2 (A) Postoperative radiographs show loss of medial and anterior cortical continouity. (B) Radiographs obtained at 4 months after operation show femoral head was penetrated by helical blade.

  • Fig. 3 The frequency of fixation failure in relation with the position of the helical blade in the femoral head. *number of fixation failure.

  • Fig. 4 (A) Anteroposterior radiographs of the right hip show displaced intertrochanteric fracture with femoral neck fracture component (arrow). (B) Immediate postoperative radiographs show anatomical reduction and acceptable position of blade. (C) Radiographs obtained at 2 years after surgery show union of the fracture with osteonecrosis of the femoral head.


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