Internal Fixation of Trochanteric Fractures of Femur Using Proximal Femoral Nail

We treated 35 trochanteric fractures of the femur using Proximal Femoral Nails (PFNs) in 5 men and 30 women with a mean age of 84.1 years (range from 65 to 97 years). According to AO classification, they were classified into 31-A1 (20 cases), 31-A2 (10 cases) and 31-A3 (5 cases). The mean PFN operation time was 52.4 minutes (range from 26 minutes to 90 minutes) and the mean amount of hemorrhage was 86.9 grams (range from 20 to 200 grams). We reamed the femoral shaft only in one case due to the thin diameter of the femoral shaft, which caused femoral shaft fracture during operation. After a follow-up period of at least 4 weeks, 17 cases could walk with or without crutches. We did not observe the cut out of the lag screw or hip pin. However, 12 cases showed over-telescoping (more than 11mm) of fracture, which caused various deformities of femoral proximal regions in 5 of them. Telescoping tends to be seen in the 31-A2 type cases and/or cases with severe osteoporosis without using the distal screw of the PFN method. These results suggested that the distal screw of the PFN should be used in 31-A2 type cases and/or cases with severe osteoporosis.