Intramedullary nail and lag-screw fixation of proximal femur fractures. Operative technique and preliminary results.

ABSTRACT

Fifty patients with intertrochanteric and subtrochanteric fractures of the femur were treated with closed reduction and internal fixation with Vector intramedullary nail (Biomet Inc, Warsaw, Indiana) and lag-screw fixation. Sixty-five percent of intertrochanteric fractures were unstable, with subtrochanteric extension in 12 cases. Lag-screw fixation preceded closed, unreamed nailing. Weight bearing, as tolerated, was initiated on the first post-operative day in all patients. Overall mortality and complications were lower than those reported in comparable series of intertrochanteric fractures treated with internal fixation. One nail breakage occurred. No cases of lag-screw cutout, nonunion, or femoral shaft fracture were documented. The Vector nail has recently been introduced as an alternative form of fixation for complex proximal femur fractures. In the present study, consistently good results were obtained, despite the stability or location of the fracture. We especially recommend using the Vector nail for managing complex, unstable intertrochanteric and subtrochanteric fractures.