Complications of internal fixation by a short proximal femoral nail (pfn) in subtrochanteric fractures

Introduction: Many implants have evolved for the management of subtrochanteric fractures, each with its associated set of complications. In this study, short PFN was used for the management of subtrochanteric fractures and various complications were noticed. Aim of study: To study Operative complications with respect to technical aspects & implant and to study the post operative complications of short PFN. Material and Methods: This study was a prospective study on adult patients of both sexes with a follow up of 24 weeks, conducted at orthopaedic department of Govt Medical College Hospital, Jammu. After proximal femoral nailing, patients were assessed clinically and radiologically on the 2nd post operative day, at 4 weeks, 12 weeks and then between 6 months to 1 year depending upon the fracture union. Results & Observations: Most of the fractures were reduced by closed reduction. In 30% of cases, mini-open reduction was required. Reduction was anatomical in 30% of cases, and acceptable in 62.5% of cases. Varus reduction was seen in 35% of cases. Proximal locking was found difficult in 30% of cases. Post operative complications were seen more in patients with other co-morbidities like diabetes milletus. Conclusion: Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Proper case selection, gradual learning and great patience is needed in order to prevent complications. Early failure is due to poor reduction, whereas non-union results in late failure.