Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 6-12 | Mithun Shetty, Shashi Kumar M.S, Shree Krishnananda Sagar

Author: Mithun Shetty [1], Shashi Kumar M.S [1], Shree Krishnananda Sagar [1]

[1] Department of Orthopaedics AJ Institute of Medical Sciences, Mangalore 575004

Address of Correspondence
Dr. Shashi Kumar,
room no #707, resident hostel aj institute of medical sciences, kuntikana, mangalore 575004


Background: Achieving reduction prior to fixation is a key aspect in successfully managing intertrochanteric fractures. In this study of proximal femoral nailing for intertrochanteric fractures, a novel technique of utilizing prefixation compression screw was introduced to achieve and maintain reduction of femoral neck shaft angle.
Materials and Methods: The current prospective study was conducted over a period of six months between July 2018 and January 2019 among patients who underwent surgical fixation by PFN for intertrochanteric fractures of femur. Prefixation compression screw was used in all the cases to achieve and maintain correction of varus. Pre-operative, intra-operative and post- operative neck shaft angles were documented. Data was analysed by using Statistical Package for Social Sciences (SPSS). The results were expressed as percentages and graphs.
Results: There is significant improvement in correction of varus (average increase of neck shaft angle =14.04 degrees) with the use of prefixation screw technique. This procedure did neither increase the blood loss (average blood loss = 34.67 ml) during the procedure nor the duration (average duration = 19.46 mins) of the procedure.
Conclusion: Prefixation compression screw can be used as an effective alternative for varus correction in cases of simple intertrochanteric fractures undergoing PFN fixation with added intra-op and post-op advantages compared to other methods of reduction.
Keywords: Intertrochanteric fractures,Proximal Femoral nailing, Prefixation screw, Varus correction


1. Koval KJ, Chen AL, Aharanoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthop Relat Res. 2004; 425:72-81.
2. Voleti PB, Liu SY, Baldwin KD, Mehta S, Donegan DJ. Intertrochanteric Femur Fracture Stability: A Surrogate for General Health in Elderly Patients?. Geriatric orthopaedic surgery & rehabilitation. 2015 Sep;6(3):192-6.
3. Pathania VP, Sharma M, Gupta S, Kaushik SK. Management of intertrochanteric fracture by PFN Vs DHS: a comparative study. Journal of Evolution of Medical and Dental Sciences. 2015 May 14;4(39):6741-51.
4. Rajarajan NS. A comparative study of treatment of unstable intertrochanteric fractures with PFN and cemented hemiarthroplasty. International Journal of Orthopaedics. 2018;4(2):111-5.
5. Marmor M, Liddle K, Buckley J, Matityahu A. Effect of varus and valgus alignment on implant loading after proximal femur fracture fixation. European Journal of Orthopaedic Surgery & Traumatology. 2016 May 1;26(4):379-83.
6. Chang WS, Zuckerman JD, Kummer FJ, Frankel VH. Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures. Clin Orthop Relat Res. 1987;(225):141-6.
7. Desjardins AL, Roy A, Paiement G, et al. Unstable intertrochanteric fracture of the femur: a prospective randomised study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br. 1993;75(3):445-7
8. Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Archives of Bone and Joint Surgery. 2016 Jan;4(1):23.
9. Bakshi DA, Kumar DP, Brar DB. Comparative study between DHS and PFN in intertrochanteric fractures of femur. IJOS. 2018;4(1):259-62
10. Kyavater BS, Gupta S. Comparative study between dynamic hip screw vs Proximal femoral nailing in unstable inter-trochanteric fractures of the Femur in adults. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES-JEMDS. 2015 Jun 22;4(50):8690-3
11. Chun YS, Oh H, Cho YJ, Rhyu KH. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clinics in orthopedic surgery. 2011 Sep 1;3(3):217-24
12. Lourenço PR, Pires RE. Subtrochanteric fractures of the femur: update. Revista Brasileira de Ortopedia. 2016 Jun;51(3):246-53
13. Kulkarni GS, Limaye R, Kulkarni M, Kulkarni S. Intertrochanteric fractures. Indian journal of Orthopaedics. 2006 Jan 1;40(1):16.
14. Siddiqui YS, Khan AQ, Asif N, et al. Modes of failure of proximal femoral nail (PFN) in unstable trochanteric fractures. MOJ Orthop Rheumatol. 2019;11(1):7‒16. DOI: 10.15406/mojor.2019.11.00460
15. K Şemmi, A Taşkın, K Cemil, et al. Mechanical failures after fixation with proximal femoral nail and risk factors. Clin Interv Aging. 2015;10:1959– 1965
16. Tank PJ, Solanki RA, Patet HK, Rathi NV, Misttry J, Bhabhor HB. Results of proximal femoral nail in intertrochanteric fracture femur. Int J Med Sci. 2016;1:17-24.
17. Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femoral nail in unstable trochanteric fractures. SICOT-J. 2017;3.

How to Cite this article: Shetty M, Kumar M.S.S, Sagar SK.Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases. Journal of Clinical Orthopaedics July-Dec 2020;5(2): 6-12.

 (Abstract    Full Text HTML)   (Download PDF)