Proximal Femoral Nail Group Research Articles

Functional Outcome in Treatment of Unstable Trochanteric and Subtrochanteric Fractures With the Proximal Femoral Nail and the Medoff Sliding Plate

To compare outcome between the proximal femoral nail (PFN) and the Medoff sliding plate (MSP) in patients with unstable trochanteric or subtrochanteric fractures. This was a consecutive prospective randomized clinical study. In all, 203 patients admitted to two university hospitals with an unstable trochanteric or a subtrochanteric fracture type were included. Surgery was performed with a short intramedullary nail or a dual-sliding plate device. Follow up visits occurred at 6 weeks, 4 months, and 12 months. Functional outcome was measured by walking ability, rising from a chair, curb test, and additional assessments of abductor strength, pain, living conditions, and complications. The ability to walk 15 m at 6 weeks was significantly better in the PFN group compared to the MSP group with an odds ratio 2.2 (P = 0.04, 95% confidence limits 1.03-4.67). No statistical difference in walking ability could be found between trochanteric and subtrochanteric fractures. The major complication rate (8% in the PFN group and 4% in the MSP group) did not differ statistically (P = 0.50) but reoperations were more frequent in the PFN group (9%) compared to the MSP group (1%; P < 0.02). There were no major differences in functional outcome or major complications between the treatment groups. Reasons other than the operated fracture seem to be equally important in determining the long-term functional ability of the patients in our study. An advantage with the MSP was the lower reoperation rate.

Vergleichsstudie der Versorgung pertrochantärer Femurfrakturen - trochanteric Gamma-Nagel vs. PFN

We have performed a retrospective comparative study between the trochanteric gamma nail (TGN) and the proximal femoral nail (PFN). During the period 1998-2003, 97 TGN and 83 PFN were used for the treatment of pertrochanteric fractures. Most of the fractures were of the A3 type according to the AO/ASIF classification. Clinical and radiological follow-ups were available for 87 TGN and 65 PFN. The mean operative time for the TGN was shorter than that for the PFN. Intraoperative complications were noted in 17.5 % and 28.8 % for the TGN and PFN groups, respectively. Late complications occurred in 18.4 % for TGN compared to 27.6 % of the PFN. Union was achieved in 94.2 % and 89.3 % of the patients treated with the TGN and PFN, respectively. The reoperation rates were 10.3 % and 24.6 % for the TGN and the PFN, respectively. Clinical outcomes were good for both groups (65 % in the TGN, 62 % in the PFN group). Treatment of pertrochanteric fractures using the TGN and PFN implants is quite reliable. The major complication was cut-out and occurred mostly in the PFN group, while varus deformity was more frequent in the TGN group. The PFN was associated with a higher rate of reoperation and longer operative time, probably due to a more demanding technique.

当院における大腿骨転子部骨折治療の検討―ＰＦＮとγ‐ｎａｉｌの比較

Between January 1997 and June 2002, 50 cases of femoral trochanteric fractures were treated with a proximal femoral nail (PFN), and 50 cases with a Gamma nail. This study evaluated the effectiveness of these fixation devices. There were no significant differences in the mean age, sex, fracture types according to Evans classification and the pre-injury walking ability between the two groups. We clinically and radiographically evaluated the two groups. More than 70 percent of the patients regained walking ability post operatively. Local complications included: three fractures the around the tip of the nail in the Gamma group and one in the PFN group, and five cases of Coxa vara deformity in the Gamma group. However, there was no incidence of cut-out in either group. These devices provide satisfactory results in the treatment of such fractures. However, we conclude that the PFN is a more useful device than the Gamma nail because femoral neck screw positioning is critical.