[Proximal femur fractures: results and complications after osteosynthesis with PFN and TGN]

Abstract

Background: The primary aim of surgery for pertrochanteric fractures of the femur is to regain preoperative mobility as quickly as possible. The aim of this study was to investigate whether clinical or radiological differences could be found between proximal femoral nails (PFN) and trochanteric gamma nails (TGN), with particular attention given to technical differences in implantation and early complications.

Patients and methods: This prospective study included 114 patients with PFN or TGN. Their average age was 78.9 years. Clinical and radiological examinations were evaluated over a 24-month period.

Results: The implantation time for PFN was 20 min less than for TGN in patients with 31A1 (AO) fractures, and 78.5% of all operations were complication-free. Problems occurred in 10 cases (seven PFN, three TGN) during nail insertion and were, in the case of TGN, all caused by fragment dislocation. Postoperative dislocation of the implant was observed in 12 cases [eight PFN (7%), four TGN (3.5%)]. Cut-out occurred in four cases with PFN implants, one of which was attributed to z-effect, and in two cases with TGN. Secondary varus deviation without cut-out occurred in one case with TGN and two cases with PFN. No significant differences in complication rates could be found between the two implants (p>0.05).

Conclusions: PFN are better suited to 31A1 fractures because of their higher rotational stability from the use of dual screws. A short femur and high antecurvation can cause insertion problems in PFN because of the nail design. It is advisable to choose the type of implant during preoperative planning after considering fracture type and patient anatomy.