Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws

Figure 1 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification of 31-A fractures. Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification as follows: (1) A1: Simple two part, lateral cortex remains intact; (2) A2: Comminuted withpostero-medial fragment,lateral cortex remains intact; and (3) A3: line extend acrossboth medial and lateralcortices,include reverseobliques.

Figure 2 Proximal lock-related complications. A: Proximal screw cut-out; B: Z-effect; C: Proximal screw back-out; D: Proximal screw breakage.

Figure 3 Distal screw breakage.

Figure 4 Typical case presentation of a patient treated with proximal femoral nail with distal interlocking screw. A: Immediate postoperative period; B: Downward migration of the nail because of distal locking; C: Windshield wiper effect around the purchase area of the screw in the head; D: Screw cut-through from the femoral head; E: Z-effect. PFN: Proximal femoral nailing; Post-OP: Postoperative period.

Figure 5 Typical case presentation of a patient treated with proximal femoral nail without distal interlocking screw. A: Immediate post-OP; B: After fracture union. PFN: Proximal femoral nailing; Post-OP: Postoperative period.

Figure 6 Case of a 68-year-old female with right intertrochanteric fracture pattern Arbeitsgemeinschaft für Osteosynthesefra-gen/Orthopaedic Trauma Association 31-A2. A: Preoperative X-ray; B: Immediate postoperative X-ray; C: After union.