Results of surgical treatment with proximal femur nail in adult femur

Abstract

Aim: Proximal femoral nails are widely used in the treatment of pertrochanteric fractures, as they can be applied in a shorter time and with less bleeding, with their more stable biomechanical properties during axial loading. In this retrospective study, conducted in our institution, we aimed to determine the effective- ness of PFN, especially in various osteoporotic conditions, mental health conditions, anesthesia risk, functional outcomes and mortality

Material and Methods: Functional and radiologic results of 109 consecutive patients with intertrochanteric femur fractures, who have undergone osteosynthesis with proximal femoral nail between October 2009 and January 2015, were examined retrospectively. In addition to demographic characteristics, the type of fracture, comorbidities, type of trauma, duration from the moment of fracture to surgery, surgery duration and complications, presence of union and position of the implant were evaluated clinically and radiologically. The American Society of Anesthesiologists (ASA) scale was used for surgical risk assessment. The Harris Hip Scoring System was used for functional evaluation.

Results: Fifty-nine patients were male and 50 were female. The mean age was 77,69 (17-102) years. The mean follow-up time was 32,9 (12-61) months. The etiology was as follows: a simple fall in %89.9 of cases, a fall from height in %7,3 of cases and motor vehicle accidents in %1,8. Operative procedures were performed within an average of 3,54 days after admission to our hospital (range 0-17 days). The average length of hospital stay was 7,76 days (range 2-56 days). Nine patients had complications related to the fracture. The mean score on the Harris scale at the last follow-up was 79,6 (48-100). The mortality rate in the first year was %29,6. A high ASA score and age over 80 years were found to generate a statistically significant increase in the risk of mortality and poor functional outcome.

Discussion: Pertrochanteric fractures are usually diagnosed in elderly patients due to low energy traumas. The first choice of treatment must be surgical for an early return to pre-fracture activity levels. The proximal femoral nail is a reliable, safe and effective treatment method for pertrochanteric fractures due to its advantages such as application with closed reduction, providing anatomic and biological fixation, short surgical time, low blood loss and complication rate, and the possibility of early weight-bearing.