Difficulties encountered during fixation of trochanteric fractures with proximal femoral nailing: A prospective analysis of 200 cases at a tertiary care centre in North-West India

Introduction: Proximal femoral nailing (PFN) compares favourably with dynamic hip screw in terms of surgical time, intra-operative blood loss and lag screw cut out in unstable inter-trochanteric fracture. However, data on difficulties faced during the fixation process are lacking. Therefore, the study was planned with the aim to identify difficulties encountered during fixation of trochanteric fractures with PFN in the patients. Materials and Methods: Two hundred patients with trochanteric fractures aimed for the operative procedure with PFN were included in the study. Patients with associated fracture of neck of femur, the shaft of the femur of the same side, with polytrauma, with multiple fractures, with pathological fractures and/or unwilling to participate in the study were excluded. Bone mineral density was evaluated using Singh's index. Fixation of trochanteric fractures was done using PFN. Results: More than 70% of the study participants were elderly, 53% of the participants were males, while 91% of the total participants belonged to a rural region. Hypertension was the most common comorbidity in 21% of the patients, followed by anaemia (14.5%) and diabetes (9%). 73% of the patients had grade 3 Singh's index. 53.5% of the patients had intra-trochanteric left femur while the remaining 46.5% of the patients had intra-trochanteric right femur. The reduction was the most common difficulty (26%) followed by entry point difficulty (21%) and guidewire passage (12.5%). No difficulty was observed in 29% of the patients. Conclusion: Achievement of good reduction between two main fragments without varus malalignment and placement of hip screw in a correct position are two important technical aspects that prevent most of the complications associated with these procedures.