Percutaneous intramedullary fixation of trochanteric fractures of the femur. Clinical trial of a new hip nail.

Since 1992, we have developed an implant which can be inserted percutaneously without reaming the femoral shaft. In the final design, the intramedullary nail is 13 mm diameter proximally and 11 mm distally. The femoral head is fixed with two screws of 6.5 mm diameter, and there is a single 4.5 mm distal screw. The nail and screws are constructed from coldworked ISO 5832-9 stainless steel. From July 1994 to June 1997, 159 patients aged over 60 years with acute trochanteric femoral fractures were treated with these implants. Results were assessed on a functional basis of walking mobility and level of dependency. After three months, 89 patients (56%) had regained their previous level of mobility and 22 patients (16%) had died from unrelated causes. Average operating time for the first 50 patients was 38 min. Complications include screw cutout in two patients, prominent screws in four, one non-union and two persistent low grade infections. The complication rate is comparable with that of other methods of treatment.