Peritrochanteric fractures treated with the Fixion expandable proximal femoral nail: technical note and report of early results

Introduction: The theoretical advantages of intramedullary fixation for peritrochanteric fractures were lessened in practice by implant-related operative problems and postoperative complication. Materials and methods: Forty-nine patients were treated with a newly designed expandable proximal femoral nail (EPFN) and followed thereafter for a minimum of 6 months. Results: After experience was gained in carrying out the procedure, its mean duration was limited to 43.4 +/- 20.2 min and total mean fluoroscopy time to 39.8 +/- 16.1 s. Due to minimal extent of soft tissue trauma blood loss was negligible and rate of postoperative infections reduced. Condensation of cancellous bone in the femoral head as an alternative to reaming and the blunt cone-shaped head of the peg reduced the frequency of head peg cut-out. Homogenic load distribution along the nail interface decreased the concentration of stress and thereby eliminated the risk of postoperative femoral fracture distal to the implant stem. Conclusion: The EPFN may be considered as a further evolution of implants designed to stabilize peritrochanteric fractures of all grades.