Proximal Femoral Neck Intramedullary Nailing with a Time Preserving Technique

Abstract

Back ground:

     Proximal femoral fractures are one of the most common fractures around the hip joint.⁽¹⁾ Proximal femoral nail antirotation (PFNA) is a novel intramedullary device with a helical blade that is inserted by impaction, causing bone compaction around the blade⁽²⁾, The procedure involves positioning the patient in different postures like:

1. a) supine position on fracture table b) In lateral position on ordinary table and c) prone position with extended posterolateral exposure mainly with the use of orthopedic table and image intensifier³

Patients and method:

      50 cases (35 female 70%, 15 males 30%) were operated upon by the same surgical team.

All the patients had intertrochanteric fracture with variable degree of severity and displacements, ranging from grade I to grade III according to Kyle, all are subjected to the same procedure which includes the following:

Patient positioning: 

The patient positioned in pure lateral position putting the normal side on the operative table while the affected side is up. The patient holdinsitu with dressing plaster straps attached between the patient abdomen and the operative table, sometimes pillows or sand bags added according to the body built of the patient, the operative time is calculated at the interval from skin incision to skin closure.

Results:

    The operative time was between 20 min and 50 min with an average of 25.1 min. which is low in comparison to other studies with p value< 0.05.

Discussion:

     In the current study we used the PNF for the fixation of the intertrochanteric fractures, which has been proved to be very good method for fast, stable, method of fixation, with little blood loss and small incision, as supported by many metanalytic researches⁽⁷⁾⁽⁸⁾, we found that putting the patient in lateral position and converting this to supine position is worthy to be taken, since it reduces the operative time and hence the consequent morbidity and mortality.

Conclusion and recommendation:

     In conclusion it has been noticed that using the special positioning procedure mentioned in the current study is helpful in passively keeping the reduction of the intertrochanteric fracture to be operated upon with special benefit in obese patients, in addition to the significant reduction of the operative time, which considered very important in reducing the morbidity both medical and surgical in these patients in particular the elderly ones, we highly recommend the procedure in reduction and fixation of any given intertrochanteric fracture.