Der proximale Femurnagel (PFN) - Verfahren der Wahl zur belastungsstabilen Versorgung von 31-A-Frakturen alter Menschen?

There is no gold standard in full-weight-bearing treatment of instable 31-A-fractures in aged people so far. In the present study we evaluate the applicability of the PFN to be considered as standard procedure in the treatment of mentioned group of geriatric patients. We analysed the treatment results in 106 patients (mean age: 84 years) with proximal femoral fracture. Surgical treatment included either implantation of hip prosthesis (n = 31) or fracture stabilization by PFN (n = 75). Proximal femoral nail-implantation revealed reduced operating times and minor surgical trauma compared to prosthetic care. Overall evaluation of the final outcome demonstrated no significant difference between both groups, though. The mean reason for that seems to be the circumstance of being forced to the specified flat rate per case. This leads to prolonged in-patient treatment, although patients with PFN-implantation experience early mobilization. Realizing the forthcoming introduction of GR-DRG-systems this aspect must be noticed carefully. The Proximal Femoral Nail represents a perfect implant for the treatment of instable A2- and A3-fractures. We can recommend PFN-implantation as full-weight-bearing standard therapy to treat those injuries in aged people. The indication to perform PFN-implantation must not be restricted by economical forces.