The Causes of Proximal Femoral Nail Complications
Birkan Kibar1, Necdet Sağlam2, Tuhan Kurtulmuş3, Gürsel Saka4, Fuat Akpınar51Department of Orthopaedic and Hand Surgeon, University of Health Sciences Türkiye, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye2Department of Orthopaedics and Traumatolology, Umraniye Training and Research Hospital, Istanbul, Türkiye
3Department of Orthopaedics and Traumatolology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Türkiye
4Department of Orthopaedics and Traumatolology, Hisar Intercontinental Hospital, Istanbul, Türkiye
5Department of Orthopaedics and Traumatolology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
INTRODUCTION: We aimed to investigate the relationship between possible causes and complications after osteosynthesis with a proximal femoral nail (PFN) in patients with intertrochanteric femoral fractures.
METHODS: A total of 122 patients (50 men, 72 women) who were followed for at least one year were analyzed retrospectively. The mean age of the patients was 74 (range: 24-97). The left side was affected in 73 patients, while the right side was affected in 49 patients. The causes of fractures were simple falls at home in 109 cases, falls from height in 6 patients, and traffic accidents in 7 cases. Patients underwent surgery an average of 6.2 days (range: 1–26) after the trauma. All operations were performed in the supine position under fluoroscopic control with manual traction.
RESULTS: According to the Harris hip score, 6.6% of patients had excellent, 18% excellent, 45% good, 21.3% fair, and 9% poor results. A total of 20 infections (8 superficial, 12 deep), 22 implant failures (12 cut-out, 6 Z-effect, 4 reverse Z-effect), 3 femoral shaft fractures distal to the PFN, 2 nonunions, 1 avascular necrosis in the femoral head, 9 sacral decubitus ulcers, 1 gluteal decubitus ulcer, 1 pulmonary embolism, and 1 thromboembolism were observed. When fracture types and implant failure were compared, the highest implant failure rate was seen in Modified Evans-Jensen type 5 fractures (36.7%), but the relationship was not statistically significant (p>0.05). Infection developed in 8 (26.7%) of 30 patients with type 5 fractures, and this relationship was found to be significant (p<0.05). No statistically significant relationship was found between the presence of systemic disease, gender, age, affected side, time between trauma and surgery, mechanism of trauma, and complications.
DISCUSSION AND CONCLUSION: Modified Evans-Jensen type 5 fractures had the highest complication rate among intertrochanteric fractures treated with PFN. Therefore, applying the nail with proper technique and achieving acceptable reduction is essential to ensure balanced osteosynthesis in such fractures.
Manuscript Language: English