J Korean Fract Soc.  2007 Jan;20(1):33-39. 10.12671/jkfs.2007.20.1.33.

Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN)

• Lee KB
• Lee BT

• KMID: 2294376
• DOI: http://doi.org/10.12671/jkfs.2007.20.1.33

Abstract

PURPOSE
We analyzed the complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFN®) to reduce the its complications.
MATERIALS AND METHODS
We evaluated the complications among 198 patients who were treated with PFN® from June 2001 to August 2005 in our hospital.
RESULTS
The complications were presented in 28 cases (14.1%). Cut-out of lag screw was in 1 case, cut-out of lag screw and antirotation screw were in 3 cases, cut-out of antirotation screw in 3 cases, of these femoral head fracture was in 1 case. Femoral neck fracture in 1 case, Osteonecrosis of femoral head in 1 case, cortical fracture during the insertion of distal interlocking screw in 1 case, breakage of drill bit intraoperatively in 1 case, fibrous union in 2 case, thigh skin irritation due to screw back-out in 3 cases, periprosthetic fractures in 2 cases, varus collapse more than 10 degrees in 4 cases, superficial and deep infections in 3 cases, breakage of nail in 1 case, varus collapse after PFN removal in 1 case, persistent thigh pain in 1 case. Of all these cases, 9 cases (4.5%) were required reoperation with general or spinal anesthesia. Complications related with screws or fracture reduction were 19 cases (9.6%) and, of these, 17 cases (89.5%) showed increased TAD (tip apex distance) or nonanatomical reduction.
CONCLUSION
To reduce the complications of PFN®, we need to exact surgical technique and anatomical reduction and consider the modification of implant design to prevent of cut-out of screws.

Keyword

Femur; Pertrochanteric fractures; Proximal femoral nail; Complications

MeSH Terms

Anesthesia, Spinal
Femoral Neck Fractures
Femur
Head
Humans
Osteonecrosis
Periprosthetic Fractures
Reoperation
Skin
Thigh

Figure

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  Fig. 1 (A) 59 years old male with intertrochanteric fracture, preoperative AP radiogrpah. (B) Immediate postoperative AP radiograph showed that antirotation screw placed higher than greater trochanter. (C) Antirotation screw showed Z-effect and penetrated the hip joint in the oblique radiograph. (D) We removed the antirotation screw. (E) Femoral head fracture was occurred after fall down. (F) Bipolar hemiarthroplasty was performed.

• 

  Fig. 2 (A) AP radiograph showed relatively extracapsular basicervical fracture. (B) Immediate postoperative AP and lateral radiograph showed anatomical reduction. (C) Postoperative 8 months, osteonecrosis of femoral head had developed. (D) Femoral head had been replaced.

• 

  Fig. 3 (A) Periprosthetic fracture was developed but fracture line was not seen definitely in the AP radiogrpah. (B) In the lateral radiograph, fracture line was observed easily near the inappropriate drilling hole which had been made intraoperatively.

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  Fig. 4 (A, B) Postoperative radiogrpah showed non-anatomical reduction in the lateral plane. (C) Reverse Z-effect phenomenon was shown at postoperative 8 months.

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  Fig. 5 (A) Immediate postoperative AP radiograph showed that antirotation screw placed higher than greater trochanter. (B) Antirotation screw showed Z-effect phenomenon and penetrated hip joint at the postoperative 6 weeks. (C) We removed antirotation screw. (D) Lag screw migrated proximally and penetrated hip joint again.

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  Fig. 6 (A, B) Postoperative radiogrpah showed non-anatomical reduction in the lateral plane. (C) Reverse Z-effect phenomenon was shown at postoperative 8 months.

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