The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)--our first 60 cases

Abstract

The most widely used implant in unstable proximal femoral fractures is the dynamic hip screw (DHS). Intramedullary implants include the intramedullary hip screw (IHMS), gamma nail and proximal femoral nail (PFN). There have not yet been any randomised trials comparing the PFN and DHS. We report our experience of stabilising 60 consecutive proximal femoral fractures with the PFN. Fifty fractures were unstable trochanteric fractures, seven were subtrochanteric (32A), one segmental, and two were at the level of a DHS plate. The mean age was 79 years and there were 12 male and 48 female patients. Twenty-eight patients were graded as ASA 3 or 4. Two patients had multiple injuries, all fractures were closed and there were five pathological fractures. The patients were followed up for a minimum of 4 months. Within this period, there were 12 deaths due to cardiopulmonary complications. Of the remaining 48 patients, two were lost to follow-up and 39 had united by 4 months. The local complications were: four implant cut-outs, two high energy fractures below the implants and one implant failure at 7 months due to delayed union. We believe that the PFN is a good choice for stabilising subtrochanteric fractures. We also believe that the use of the PFN for unstable trochanteric fractures is very encouraging. A large, randomised controlled trial against the DHS would be helpful to clarify the relative risks and benefits.