theo at asumu
Sep 30, 2006, 2:16 AM
Post #5 of 5
The main advantage of a short nail is the ability to carry our distal
locking through the jig.
Short proximal femoral nails (as a generic group regardless of
manufacturer) tend to be straight on the lateral view. There is no
antecurvature to match the femur. Patients with excessive bowing of the
femur often end up with the tip of the nail abutting against the
anterior cortex. This stress riser can lead to peri-implant fractures.
The true incidence of this complication is difficult to estimate. A
study in 1993 (1) reported an 11% incidence with the gamma nail.
Changes in design have lead to a reduced rate of shaft fractures but the
rate still exceeds that seen following a dynamic hip screw.
The long nail with an antecurvature was designed to avoid this
complication. There remains an incidence of fracture at the tip of the
long nail. Robinson's group in Edinburgh (2) had 5 such fractures
occurring within 8 weeks of surgery in 302 patients (1.6% incidence).
Other disadvantages of the short nail, in my opinion include the
limitation of the short nail in dealing with fractures extending low in
the subtrochanteric region.
My preference is to use the long nail for all such fractures. In purely
trochanteric fractures, I do not lock distally.
1) Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of
intertrochanteric fractures of the femur. A randomised prospective
comparison of the gamma nail and the dynamic hip screw. J Bone Joint
Surg Br. 1991;73:330 -4.
2) C. Michael Robinson, S. Houshian, and L.A.K. Khan
Trochanteric-Entry Long Cephalomedullary Nailing of Subtrochanteric
Fractures Caused by Low-Energy Trauma
J. Bone Joint Surg. Am., Oct 2005; 87: 2217 - 2226.
Mr Theophilus Asumu FRCS (Tr & Orth)
Consultant in Trauma and Orthopaedic Surgery
From: george therthanath [mailto:firstname.lastname@example.org]
Sent: 27 September 2006 07:14
To: Indiaorth@indiaorthmail.com; email@example.com
Subject: PFN - LONG or SHORT
We have recently started using PFN(Indian) for our pertrochanteric
fractures. Can I ask the more experienced surgeons on their preference
of nail? LONG OR SHORT PFN? What is the reported incidence of shaft
fractures following short PFN?
Can my Indian colleagues tell us the names of manufacturers with
Thanks in advance.
Dr. T. I. George,
Senior Orthopaedic Surgeon
Head of Orthopaedics Unit-III,
Little Flower Hospital and research Centre,
Angamaly, Kerala State,