PFNA nail – An excellent solution for intertrochanteric or subtrochanteric fractures in the elderly

Yesterday, the doctor received an 85-year-old female patient who suffered a right intertrochanteric fracture of the femur due to a fall. The patient is elderly, osteoporotic, and has underlying conditions of diabetes and hypertension. Through a friend, the family was referred to me to perform the surgery.

Image 1: Intertrochanteric fracture site

In the past, these types of fractures were usually indicated for conservative treatment due to concerns regarding anesthesia and postoperative resuscitation. Surgical methods using plate fixation and open reduction required large incisions and significant blood loss, leading to many difficulties in postoperative recovery, and even resulted in mortality for some patients.

In 2019, while completing my residency in Paris, I had the opportunity to practice performing intramedullary nailing for intertrochanteric femoral fractures. In France, this nail is called a gamma nail (clou gamma). The advantages of this method are reduction under fluoroscopy (X-ray), a small incision, minimally invasive approach, rigid bone fixation, early postoperative mobilization, and particularly a very "smooth" postoperative course with no blood loss. Actually, this method is not new at all; it was conceived by the French themselves more than 40 years ago at the Strasbourg University Hospital. In Vietnam, this method was only gradually applied around 2020.

For this case, I naturally explained the same method to the patient's family. The surgery took 15 minutes with 3 very small incisions. 12 hours postoperatively, the patient was pain-free, had good hip range of motion, and was able to sit up, turn, and stand up with a walker. The patient was alert, without anemia, and cheerfully answered the doctor's questions. During the ward round, I could sense the joy and optimism of the patient's daughter, or perhaps a mixture of relief and anxiety would be more accurate. She continuously asked me if her mother could do this or that. I spent about 10 minutes answering her questions and concluded with the statement: "Tomorrow your mother can go home."

Image 2: Patient after surgery & surgical scar

Image 3: Postoperative X-ray of the patient

For a surgeon, seeing one's patient recover healthily is truly a great happiness. Many elderly patients have been cured by me using this method. Most recently, there was also an 27 kg elderly woman with an intertrochanteric fracture who recovered 2 months after surgery; I joked: "With this nail added, the patient might just weigh 28 kg."

Image 4: The elderly woman after surgery, already able to walk and mobilize

Image 5: Postoperative X-ray of the elderly female patient

Another male patient case, 90 years old:

Image 6: 90-year-old male patient after surgery & surgical wound

Image 7: Postoperative X-ray of the male patient