Proximal femoral nailing for intertrochanteric fracture

Case contributed by Amanda Er

Presentation

Fell onto right hip with tenderness on palpation. Post-operative internal fixation for right proximal femur fracture performed 3 days after initial presentation.

Patient Data

Age: 70 years
Gender: Male

Initial presentation

X-ray

There is a mildly displaced, comminuted intertrochanteric fracture of the right femur. The femoral heads are enlocated. No pelvic fracture is seen.

Internal fixation of the right proximal femoral fracture is seen with expected post-surgical soft tissue changes in the right proximal thigh in the gluteal region. The knee joint is congruent albeit with a small suprapatellar effusion.

Case Discussion

In this case, the patient has sustained a mildly-displaced intertrochanteric fracture, which is often stabilized using surgical means. Doing so will prevent propagation and completion, subsequent displacement, or other injuries that may require a more invasive surgical approach 1. A proximal femoral nail (PFN) fixation is one of the surgical treatments for proximal femoral fractures and is being used in this case.

Implant position, fragment position and fracture healing can be evaluated with an anteroposterior view and lateral radiograph of the implant. Radiographers performing post-operative imaging for such patients should ideally ensure that the entire length of the PFN can be assessed in a single image.

Post-operative notes on the implant used:

  • Synthex long TFNA 10mm 360mm
  • helical blade 105mm
  • 4ml cement
  • distal locking bolt 46mm & 48mm

Disclaimer:
I, Amanda Er, have no actual or potential ethical or financial conflict of interest in relation to the aforementioned device. This case is not intended to be a personal endorsement or recommendation of these products.

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