To evaluate the clinical result of Proximal Femoral Nail (PFN) fixation for intertrochanteric fracture of the femur in elderly patients.

Between January 2004 and June 2006, 119 patients older than 65 years of age, with intertrochanteric fractures, were treated with PFN fixation. Ten patients who died within 4 weeks after operation were excluded from the analysis. Mean duration of follow-up was 13 months. There were 34 males and 75 females, and the mean age was 77.8 years. Operation time, amount of blood loss, transfusion requirement, time to ambulation, length of hospital stay, pre- and post-operative walking status, and post-operative complications were evaluated. Radiologic parameters such as amount of impaction, time to union, and neck-shaft angle were also evaluated.

The mean operation time was 42 minutes, transfusion requirement averaged 340 ml, and amount of blood loss averaged 78 ml. The mean hospital stay was 20 days, and time to ambulation averaged 10.3 days. Eighty-five percent of patients returned to previous walking status. The average amount of fracture impaction was 3.8 mm, and mean time to radiologic bony union was 11.7 weeks. Neck-shaft angle was changed to 2.5 degrees varus displacement. Complications included intraoperative femur shaft fracture in 5 cases, protrusion of lag screw into the hip joint in 3 cases, backing out of lag screw in 2 cases, fixation failure in 2 cases, and proximal femur fracture in 1 case. Among these cases, 5 hips (2 cases of fixation failure and 3 cases of femoral head perforation by lag screw) were converted to total hip replacement.

Because of reduction in operation time, low complication rate, and favorable outcome, PFN fixation is an acceptable alternative for fixation of intertrochanteric fractures in elderly patients.