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Proximal Femoral Nail (PFN) Fixation

Overview

Proximal Femoral Nail (PFN) fixation is a surgical procedure commonly used to treat fractures of the proximal femur (upper thighbone), especially intertrochanteric and subtrochanteric fractures. These fractures typically occur due to trauma or osteoporosis, making the treatment critical for the elderly population. PFN is an intramedullary nail system designed to stabilize and facilitate healing of these fractures. It is inserted through a small incision near the hip, providing support and promoting early mobilization of the patient.

Specialty of PFN Fixation

PFN fixation is a specialty procedure performed by orthopedic surgeons, especially those trained in trauma and fracture care. It is particularly beneficial for elderly patients with osteoporosis or those who have suffered complex fractures around the hip. The technique requires precision and skill in nail and screw placement for optimal outcomes. Orthopedic trauma specialists often lead these procedures.

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How is Proximal Femoral Nail (PFN) Fixation Done?

Preoperative Evaluation:
  • Medical History: Review of the patient’s medical history, including any comorbidities such as osteoporosis, diabetes, or cardiovascular issues.
  • Imaging: X-rays and CT scans are used to assess the type and extent of the fracture.
  • Blood Tests: Routine blood work to evaluate hemoglobin levels, blood glucose, and coagulation profiles.
  • Anesthesia Evaluation: The patient is assessed for fitness for general or regional anesthesia (e.g., spinal or epidural).
Patient Positioning:
  • The patient is positioned supine on a fracture table.
  • The affected leg is prepared and draped in sterile conditions.
Informed Consent:
  • The procedure, benefits, risks, and possible complications are explained to the patient, and written consent is obtained.

Anesthesia:
  • General anesthesia or spinal/epidural anesthesia is administered.
Incision and Entry Point:
  • A small incision is made in the proximal femur, just below the greater trochanter.
  • A guidewire is inserted through the entry point into the femoral shaft.
Reaming:
  • The medullary canal is reamed (widened) to accommodate the nail.
Insertion of the PFN:
  • The proximal femoral nail, which has locking screws, is inserted into the femur.
  • It is guided into position under fluoroscopic (X-ray) control.
Screw Placement:
  • A proximal screw is placed into the femoral head for stable fixation.
  • Distal locking screws are inserted through the lower part of the nail to prevent rotation and allow for stabilization.
Closure:
  • The incision is closed in layers with sutures, and a sterile dressing is applied.
Postoperative Care:
  • The patient is usually allowed to mobilize with weight-bearing as tolerated, often starting the day after surgery.

Intraoperative:
  • Malposition of the nail or screws.
  • Fracture of the femoral shaft during nail insertion.
  • Blood loss or damage to surrounding structures like vessels or nerves.
Postoperative:
  • Infection at the surgical site.
  • Nonunion or delayed union of the fracture.
  • Screw cutout or migration.
  • Avascular necrosis of the femoral head.
  • Thromboembolic events like deep vein thrombosis (DVT).
Long-term:
  • Leg length discrepancy.
  • Implant failure requiring revision surgery.
What are the Benefits of Proximal Femoral Nail (PFN) Fixation
  • Minimally Invasive: The procedure involves smaller incisions compared to traditional open surgeries, which reduces postoperative pain and speeds recovery.
  • Early Mobilization: Patients are typically allowed to bear weight on the operated limb shortly after surgery, which promotes faster rehabilitation.
  • Effective Stabilization: PFN provides strong internal fixation for unstable fractures, ensuring better alignment and healing.
  • Reduced Hospital Stay: Patients experience shorter hospital stays and faster recovery times compared to open surgical procedures.
Specialty

Proximal Femoral Nail (PFN) Fixation is typically performed by ophthalmologists specializing in cataract surgery. These surgeons are trained in advanced microsurgical techniques and have expertise in lens implantation.

Infrastructure and Facility Requirements

Operating Room:
  • A sterile and well-equipped operating room with fluoroscopy (C-arm) for intraoperative imaging.
  • Specialized orthopedic equipment including fracture tables for positioning.
  • Orthopedic Instruments: PFN implant system, reamers, and guides for accurate nail and screw placement.
  • Anesthesia Support: Access to anesthesia equipment and personnel skilled in both general and regional anesthesia techniques.
Postoperative Care:
  • Access to a dedicated recovery room and intensive care unit (ICU) for postoperative monitoring.
  • Physical therapy and rehabilitation services are crucial for recovery.
  • Radiology Services: Immediate access to X-ray and CT scan facilities for postoperative assessment.

FAQs

Recovery time can vary but typically ranges from 6 to 12 weeks for the bone to heal, with the patient able to walk with partial weight-bearing within a few days post-surgery.

PFN fixation is ideal for intertrochanteric and subtrochanteric fractures but may not be suitable for fractures of the femoral neck, which often require other forms of treatment.

Patients are encouraged to engage in physical therapy and avoid heavy lifting or high-impact activities during recovery. Maintaining bone health through diet and exercise is also important.

The procedure generally takes about 1 to 2 hours, depending on the complexity of the fracture.

In most cases, the nail is left in place unless it causes discomfort or complications. If necessary, it can be removed after the fracture has completely healed.

While the risk is low, patients must follow their rehabilitation program and take precautions to avoid falls and trauma to reduce the risk of re-fracture.

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Copyright 2025 TRSCH - All Rights Reserve

Website Design and Development by Sterco Digitex

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