Short proximal femoral nail fixation for trochanteric fractures.

Purpose: To review outcomes of 100 patients who underwent short proximal femoral nailing for stable and unstable intertrochanteric fractures.

Methods: Records of 62 men and 38 women aged 56 to 83 (mean, 67) years who underwent short proximal femoral nailing for stable peritrochanteric A1 (n=36), unstable peritrochanteric A2 (n=40), and unstable intertrochanteric A3 (n=24) fractures were reviewed.

Results: 80 patients achieved anatomic reduction. At the one-year follow-up, 90% of the patients had good or excellent outcomes, and 50% had returned to their pre-injury functional level. One patient with avascular necrosis noted at 20 months and another patient with non-union/pseudarthrosis underwent a revision bipolar arthroplasty. Two patients had a Z effect and one a reverse Z effect. Six patients with osteoporosis had superior migration of the nail with varus collapse. Two patients had cutting out of the screw, but the fractures eventually healed. Ten patients had shortening of <2 cm. Seven patients had lateral thigh discomfort attributed to irritation of the protruding screws against the tensor fascia lata, and 5 of them underwent screw removal. None had fractures of the femoral shaft or trochanter or experienced nail breakage.

Conclusion: The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora.