Factors affecting the functional outcome and implant failure of proximal femoral nail (PFN) for treatment of intertrochanteric fractures

Abstract

Background: Various implants have been developed to stabilize intertrochanteric fractures from the earlier days. Recent techniques of closed reduction and internal fixation by intramedullary device are more popular and have given favorable results, as these devices are bio-mechanically more stable, cause less trauma to the soft tissues and also preserve the fracture hematoma. This study was conducted to know the functional outcome, technical complications, and factors predicting the failure of the implant by treating intertrochanteric fractures by proximal femoral nailing (PFN). Methods: From October 2017 to December 2019 we treated 60 patients with stable and unstable intertrochanteric fractures with PFN. Mean age of the study population was 64.10 years. Those who had bilateral hip fractures, patients with pathological fractures, who underwent previous hip surgery for the same or opposite side are excluded from the study. Results: 81.7% patients had excellent and good outcome and 18.3% patients had fair and poor outcome at the end of 1-year follow-up. Fair and poor results were observed in patients who belonged to higher age group (p=0.001), associated with co-morbid conditions (p=0.01) and who had complications.4 patients developed complications related to the implant (3 –proximal screw cut-out and 1 z-effect). Complications were observed in patients in whom fractures were fixed with high values of tip apex distance (TAD), calcar referenced tip apex distance (CalTAD), Parker’s ratio index (p