Kee-Byoung Lee; Byung-Taek Lee

doi:10.12671/jkfs.2007.20.1.33

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Original Article
Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN): Kee-Byoung Lee, M.D., Byung-Taek Lee, M.D.; Journal of the Korean Fracture Society 2007;20(1):33-39.
DOI: https://doi.org/10.12671/jkfs.2007.20.1.33
Published online: June 14, 2016

Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea.

Address reprint requests to: Byung-Taek Lee, M.D. Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Anyang 431-070, Korea. Tel: 82-31-380-1814, Fax: 82-31-382-1814, btleemd@naver.com

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Abstract
REFERENCES

Abstract

Purpose
We analyzed the complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFN®) to reduce the its complications.
Materials and Methods
We evaluated the complications among 198 patients who were treated with PFN® from June 2001 to August 2005 in our hospital.
Results
The complications were presented in 28 cases (14.1%). Cut-out of lag screw was in 1 case, cut-out of lag screw and antirotation screw were in 3 cases, cut-out of antirotation screw in 3 cases, of these femoral head fracture was in 1 case. Femoral neck fracture in 1 case, Osteonecrosis of femoral head in 1 case, cortical fracture during the insertion of distal interlocking screw in 1 case, breakage of drill bit intraoperatively in 1 case, fibrous union in 2 case, thigh skin irritation due to screw back-out in 3 cases, periprosthetic fractures in 2 cases, varus collapse more than 10 degrees in 4 cases, superficial and deep infections in 3 cases, breakage of nail in 1 case, varus collapse after PFN removal in 1 case, persistent thigh pain in 1 case. Of all these cases, 9 cases (4.5%) were required reoperation with general or spinal anesthesia. Complications related with screws or fracture reduction were 19 cases (9.6%) and, of these, 17 cases (89.5%) showed increased TAD (tip apex distance) or nonanatomical reduction.
Conclusion
To reduce the complications of PFN®, we need to exact surgical technique and anatomical reduction and consider the modification of implant design to prevent of cut-out of screws.
Key words: Femur, Pertrochanteric fractures, Proximal femoral nail, Complications

REFERENCES

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Fig. 1

(A) 59 years old male with intertrochanteric fracture, preoperative AP radiogrpah.

(B) Immediate postoperative AP radiograph showed that antirotation screw placed higher than greater trochanter.

(C) Antirotation screw showed Z-effect and penetrated the hip joint in the oblique radiograph.

(D) We removed the antirotation screw.

(E) Femoral head fracture was occurred after fall down.

(F) Bipolar hemiarthroplasty was performed.

Fig. 2

(A) AP radiograph showed relatively extracapsular basicervical fracture.

(B) Immediate postoperative AP and lateral radiograph showed anatomical reduction.

(C) Postoperative 8 months, osteonecrosis of femoral head had developed.

(D) Femoral head had been replaced.

Fig. 3

(A) Periprosthetic fracture was developed but fracture line was not seen definitely in the AP radiogrpah.

(B) In the lateral radiograph, fracture line was observed easily near the inappropriate drilling hole which had been made intraoperatively.

Fig. 4

(A, B) Postoperative radiogrpah showed non-anatomical reduction in the lateral plane.

(C) Reverse Z-effect phenomenon was shown at postoperative 8 months.

Fig. 5

(A) Immediate postoperative AP radiograph showed that antirotation screw placed higher than greater trochanter.

(B) Antirotation screw showed Z-effect phenomenon and penetrated hip joint at the postoperative 6 weeks.

(C) We removed antirotation screw.

(D) Lag screw migrated proximally and penetrated hip joint again.

Fig. 6

(A, B) Postoperative radiogrpah showed non-anatomical reduction in the lateral plane.

(C) Reverse Z-effect phenomenon was shown at postoperative 8 months.

Table 1

Anatomical reduction criteria

Table 2

Analysis of complications according to age and sex.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Proximal Femoral Nail Mechanical Failure: A Case Report and Biomechanical Study
Dimitrios Papanikolopoulos, Christos Kalligeros, Apostolos Polyzos, Vasileios Spitas, Vasileios Soranoglou
Cureus.2022;[Epub] CrossRef
Clinical and radiological outcomes of patients treated with the talon distalfix proximal femoral nail for intertrochanteric femur fractures
Furkan Yapici, Hanifi Ucpunar, Yalkin Camurcu, Necati Emirhan, Oguzhan Tanoglu, Ismail Tardus
Injury.2020; 51(4): 1045. CrossRef
Implant Fracture Analysis of the TFNA Proximal Femoral Nail
Anton Lambers, Bertram Rieger, Alan Kop, Peter D’Alessandro, Piers Yates
Journal of Bone and Joint Surgery.2019; 101(9): 804. CrossRef
Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?
Won Chul Shin, Jung Dong Seo, Sang Min Lee, Nam Hoon Moon, Jung Sub Lee, Kuen Tak Suh
Hip & Pelvis.2017; 29(2): 104. CrossRef
Avascular necrosis of the femoral head following trochanteric fractures in adults: A systematic review
Antonio Barquet, Gabriel Mayora, Joao Matheus Guimaraes, Roberto Suárez, Peter V. Giannoudis
Injury.2014; 45(12): 1848. CrossRef
Anatomical Measurement of Normal Korean Proximal Femur Using Plain Radiography: A Problem when using Proximal Femoral Nail Anti-rotation
Jong-Seok Park, Woo-Jong Kim, Jae-Wan Soh, Byung-Woong Jang, Tae-Heon Kim, You-Sung Suh
Hip & Pelvis.2011; 23(4): 303. CrossRef
PFNA and PFN in Intertrochanteric Fractures - Comparison Study of Sliding -
Suk Kyu Choo, Hyoung Keun Oh, Jun Young Choi
Hip & Pelvis.2010; 22(1): 79. CrossRef

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Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN)

J Korean Fract Soc. 2007;20(1):33-39. Published online January 31, 2007

DOI: https://doi.org/10.12671/jkfs.2007.20.1.33

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Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN)

Fig. 1 (A) 59 years old male with intertrochanteric fracture, preoperative AP radiogrpah. (B) Immediate postoperative AP radiograph showed that antirotation screw placed higher than greater trochanter. (C) Antirotation screw showed Z-effect and penetrated the hip joint in the oblique radiograph. (D) We removed the antirotation screw. (E) Femoral head fracture was occurred after fall down. (F) Bipolar hemiarthroplasty was performed.

Fig. 2 (A) AP radiograph showed relatively extracapsular basicervical fracture. (B) Immediate postoperative AP and lateral radiograph showed anatomical reduction. (C) Postoperative 8 months, osteonecrosis of femoral head had developed. (D) Femoral head had been replaced.

Fig. 3 (A) Periprosthetic fracture was developed but fracture line was not seen definitely in the AP radiogrpah. (B) In the lateral radiograph, fracture line was observed easily near the inappropriate drilling hole which had been made intraoperatively.

Fig. 4 (A, B) Postoperative radiogrpah showed non-anatomical reduction in the lateral plane. (C) Reverse Z-effect phenomenon was shown at postoperative 8 months.

Fig. 5 (A) Immediate postoperative AP radiograph showed that antirotation screw placed higher than greater trochanter. (B) Antirotation screw showed Z-effect phenomenon and penetrated hip joint at the postoperative 6 weeks. (C) We removed antirotation screw. (D) Lag screw migrated proximally and penetrated hip joint again.

Fig. 6 (A, B) Postoperative radiogrpah showed non-anatomical reduction in the lateral plane. (C) Reverse Z-effect phenomenon was shown at postoperative 8 months.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN)

Table 1

Anatomical reduction criteria

Table 2

Analysis of complications according to age and sex.

Table 1 Anatomical reduction criteria

Table 2 Analysis of complications according to age and sex.