Mechanical failures after fixation with proximal femoral nail and risk factors

Figures & data

Table 1 Salvati and Wilson assessment score

	Scores
Pain
Constant and unbearable, frequent strong analgesia	0
Constant but bearable, occasional strong analgesia	2
None or little pain at rest, pain with activities	4
Little pain at rest, pain on activity	6
Occasional slight pain	8
No pain	10
Walking
Bedridden	0
Wheelchair	2
Walking frame	4
One stick, limited distances up to 400 yards	6
One stick, long distances	8
Unaided and unrestricted	10
Muscle power and motion
Ankylosing and deformity	0
Ankylosing with good functional position	2
Poor muscle power; flexion <60°; abduction <10°	4
Fair muscle power; flexion 60°–90°; abduction 10°–20°	6
Good muscle power; flexion >90°; abduction >20°	8
Normal muscle power; full range of movement	10
Function
Bedridden	0
House-bound	2
Limited housework	4
Most housework	6
Very little restriction	8
Normal activities	10

Table 2 Demographic characteristics of patients

Number of patients	152 (152 hips)
Age, mean (range) (years)	76 (21–93)
Sex, n (%)
Female	85 (55.9)
Male	67 (44.1)
Location, n (%)
Right hip	79 (51.9)
Left hip	73 (48.1)
Type of fracture (AO/OTA), n (%)
A1	24 (15.8)
A2	107 (70.4)
A3	21 (13.8)

Abbreviation: AO/OTA, American Orthopedic/Orthopedic Trauma Association.

Table 3 Late complications and surgical procedures

	Cases
Late complications
Secondary varus deformity	13
Neck screw cutout	4
Z-effect	3
Reverse Z-effect	2
Muscle pain (due to nail-point effect)	7
Fracture of distal locking screw	4
Nonunion	3
Surgical procedures
Partial hip arthroplasty	6
DCS	1
Shortening of femoral head screw	1
Total hip arthroplasty	2
Removal of PFN	1
Removal of femoral head screws	3

Abbreviations: PFN, proximal femoral nail; DCS, dynamic condylar screw.

Figure 1 (A and B) Images of lateral migration of PFN head screws and cutout.

Abbreviation: PFN, proximal femoral nail.

Figure 2 (A–E) Femoral head fracture due to the lateral thigh pain in a patient in whom PFN screws were removed undergoing partial hip arthroplasty.

Abbreviation: PFN, proximal femoral nail.