OBJECTIVE: Identifying the rate of healing of unstable trochanteric fractures submitted to osteosynthesis with a proximal femoral nail (PFN® - AO/ASIF), in patients operated on between November 1999 and March 2004. METHODS: 45 patients were analyzed, ages ranging from 60 to 93, with unstable trochanteric fractures of the femur submitted to osteosynthesis with short PFN®, with indirect reduction in a traction device guided by radioscopy. The fractures were classified according to the AO/OTA classification. Bone quality was evaluated by the Singh index in the post-operative radiographic routine. The quality of the reduction achieved and the positioning of the implant were evaluated by post-operative anteroposterior and profile X-ray of the proximal femur, with analysis of the cervicodiaphyseal angle and the distance between the tip of the sliding nail and the center of the femoral head, the so-called "tip apex distance" (TAD). RESULTS: The mean age of patients studied was 80.8 years (60-93). Females prevailed, with 37 cases (82.2%). The right side was involved in 22 cases (48.89%) and the left side, in 23 (51.1%). All fractures were unstable, 22 of them of the type 31A2 (48.8%), and 23, of the type 31A3 (51.1%). Mean time of use of radioscopy was 102.4 seconds (61-185). The difference in the radioscopy time for reduction and fixation between the two groups of fractures studied was not significant (p = 0.62). Regarding bone quality, 82.2% of the patients presented a Singh index lower than IV, characterizing loss of normal bone architecture. Regarding fracture healing, forty-four cases had a successful evolution in a mean time of 3.2 months, ranging from two to seven months. In seven cases, there was a need of a new surgery, four to remove the synthesis material due to migration of the proximal screws of the nail. One case of type 31A2 fracture, due to an inadequate varus reduction, had a cutout that required surgical revision. Another case of type 31A2 fracture evolved to avascular necrosis of the femoral head after the fracture healed. Finally, one case of type 31A3 fracture, due to inadequate reduction in the sagittal plane, evolved to delayed healing, and the nail broke 13 months after surgery. CONCLUSION: Osteosynthesis with proximal nail to treat unstable trochanteric fractures of the femur performed in patients older than 60 years, resulted in healing in most cases. Complications were different in the two subgroups studied. Adequate reduction of the fracture before introducing the nail is basic to achieve success in the procedure.
Hip fractures; Fracture fixation, internal; Femoral fractures; Bone nails; Fracture healing; Postoperative complications; Aged
