[Osteosynthesis of hip and femoral shaft fractures using the PFN-long]

Abstract

Purpose of the study: A group of 79 patients with ipsilateral fractures of the hip and femoral shaft treated with the use of a long proximal femoral nail (PFN-long) was retrospectively evaluated.

Material: From January 1998 to February 2005, 79 patients were treated surgically. The group included 42 men and 37 women at an average age of 56.6 years. In 47 patients (37 men and 10 women; average age, 38 years; range, 18-72 years) the fractures were due to a high-energy trauma. In the remaining 32 patients (six men and 25 women; average age, 77.6 years), the cause of fracture was a low-energy trauma, most frequently an ordinary fall. The fractures were categorized according to the Dousa, Bartonícek and Krbec classification. Type IV fractures, i. e., subtrochanteric fractures involving the whole upper half of the femur, were most frequent.

Methods: The Synthes PFN-long is based on the PFN and partly also UFN implants. The nail is matched to femoral shaft antecurvation, and femoral neck screws have a 10 degrees anteversion. The nail is cannulated, is 10 mm thick and is available in three lengths with a distal dynamic opening.

Results: The results are based on the evaluation of 65 patients followed up for at least 12 months. At 12 months bone union was achieved in all patients; in 38 patients (58 %) it occurred by 6 months and in 59 patients (91 %) by 9 months. The outcomes were excellent in 42 (64 %), good in 18 (28 %) and satisfactory in 5 patients (8 %). Thirteen intra-operative complications (27 %) in nine patients were recorded, with the necessity of repeat surgery in four cases. Two problems were involved: incomplete reduction (nine fractures) and incorrect implant insertion (four fractures). Early complications included hematoma in the wound in five cases and one infected wound.A late complication was delayed union in two cases.

Discussion: The management of ipsilateral fractures of the hip and femoral shaft is still associated with a high percentage of complications, mostly due to reduction being difficult. The PFN-long is an implant combining the advantages of the short PFN and UFN systems. Our results are in agreement with the literature data on similar fractures treated with second-generation reconstruction nails and have a lower percentage of complications, even though our group had different characteristics in terms of a higher average age and nearly equal numbers of men and women.

Conclusions: The PFN-long is a high-quality implant that increases our options of treatment. Of all the reconstruction nails, it has most advantages. The availability of only three sizes (in three lengths with one thickness) is a certain disadvantage.