Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Section I Subtrochanteric fractures of the femur
- Section II Fractures of the femoral shaft
- Section III Fractures of the distal femur
- Chapter 11
- Chapter 12
- Chapter 13
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section I - Subtrochanteric fractures of the femur
from Chapter 10
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Section I Subtrochanteric fractures of the femur
- Section II Fractures of the femoral shaft
- Section III Fractures of the distal femur
- Chapter 11
- Chapter 12
- Chapter 13
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
INTRAMEDULLARY FIXATION FOR SUBTROCHANTERIC FRACTURES USING A PROXIMAL FEMORAL NAIL (PFN)
Indications
Low and extended subtrochanteric fractures.
Ipsilateral femoral neck and shaft fractures.
Unstable inter-trochanteric fractures.
Failed plate fixation of subtrochanteric fractures.
Pathological fractures.
Pre-operative planning
Clinical assessment
Obtain a thorough patient's history (mechanism of injury, past medical records).
Mechanism of injury: as a result of low-energy trauma in patients with osteoporotic bones (watch for underlying pathology).
High-energy trauma: motor vehicle accidents, falls from a height, gunshot injuries.
In polytrauma patients the Advanced Trauma Life support (ATLS) protocol must be followed.
Look for associated injuries, especially in polytrauma patients.
The extremity is shortened, the thigh is swollen and there is a prominence of the proximal fragment.
Neurologic and vascular injuries are uncommon; however, neurovascular assessment is mandatory.
Although rare, be alert for signs of compartment syndrome.
Radiological assessment
High-quality anteroposterior (AP) and lateral radiographs of the femur including the knee, the femoral neck and head (Fig. 10.1a,b).
Anteroposterior radiograph of the pelvis.
Look for extension of the fracture into the greater trochanter and piriformis fossa.
Contralateral radiographs of the unaffected femur are useful in assessing the width of the medullary canal, the shaft-neck angle and for the determination of the nail's length.
Operative treatment
Anaesthesia
Spinal or general anaesthesia.
Prophylactic antibiotic as per local hospital protocol.
Table and equipment
PFN set (Fig. 10.2).
Standard osteosynthesis set as per local hospital protocol.
An image intensifier.
- Type
- Chapter
- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 168 - 176Publisher: Cambridge University PressPrint publication year: 2006