ABSTRACT

To evaluate the clinical outcomes in elderly patients who underwent surgery for intertrochanteric fractures with proximal femoral nails (PFNs).

This retrospective study was conducted with 48 patients ≥60 years age, underwent surgery with Trigen Intertan nail between March 2014-September 2016 and had at least 1-year follow-up duration. Tipapex distance (TAD) and quality of the reduction were evaluated on postoperative radiographs. Complications during the follow-up period and the treatments applied were recorded.

The fractures were classified according to AO/OTA classification; 25(52%) were type 31.A2, 14(29%) were type 31.A3 and 9(19%) were type 31.A1 fractures. Mean follow-up duration was 16.9±4.3 months and TAD was 26.4±5.5 mm. Reduction quality was good in 26(54%), moderate in 18(38%) and poor in 4(8%) patients. Complications were iatrogenic fracture in 1(2%), cut-out in 5(%10), lateral migration of screws in 1(2%) and superficial infection in 2(4%) patients. These patients were treated with secondary procedures and all were mobilized. Non-union wasn’t observed in any patient. Cut-outs were observed meanly in 1.7±0.7 months; fracture types were 31.A3 in 2, 31.A2 in 2 and 31.A1 in 1 patient. Mean TAD of these patients was 28±3.8 mm and reduction quality was considered as bad in 3, moderate in 1 and good in 1 of them.

We observed that, PFNs were successful and complication rates were relatively low, when they performed following a good fracture reduction and with ideal TAD. When these principles were not fallowed, fixation problems were observed, especially in unstable fractures and secondary procedures were needed.