[Stabilization of unstable intertrochanteric fractures with the proximal femoral nail]

Abstract

Objective: Restoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis.

Indications: Unstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region.

Contraindications: Ipsilateral coxarthrosis, open growth plate, hip fracture.

Surgical technique: Closed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary.

Postoperative management: Weightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary.

Results: The stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.