The V-effect in fixation of intertrochanteric fractures with proximal femoral nails

• Published in: Orthopaedics & traumatology, surgery & research Vol. 107; no. 3; p. 102863
• Main Authors: Eceviz, Engin, Cevik, Huseyin Bilgehan
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.05.2021
• Subjects: Complication; Intertan; PFN; PFNA; Profin; V-effect; Profin; Complication; PFN; V-effect; PFNA; Intertan
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2021.102863

•The V-effect, which is an iatrogenic complication during fixation of ITFF with PFN, causes a varus of the femoral neck relative to the femoral shaft.•The V-effect is seen at a considerable rate and is an important complication with a high re-operation rate.•To avoid V-effect, we have to ensure that the guide wire enters the entry point according to the design of the PFN, and the first reamer should be in the shape of a punch instead of creating a hinge effect by entering the PFN to the fracture line. Although one of the optimal treatment methods for fixing intertrochanteric femur fractures (ITFF) is the proximal femoral nail (PFN) that still has some complications, during implantation of PFN, there might be a V-effect on the trochanteric fracture line, which leads to hinging from the inferior of the femoral neck of the fracture and consequently, fixation of the hip in a varus position. The aim of this study was to identify the causes of the V-effect, and possible preventative solutions. The V-effect is seen at a considerable rate and is an important iatrogenic complication with a high re-operation rate. A retrospective review of ITFFs treated with PFN was conducted. Fractures were classified from the injury films using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification, and quality of reduction, rate of complication and re-operation, and the V-effect was evaluated on the initial postoperative films. A total of 667 patients met the inclusion criteria. The overall rate of complications was 19.8% and re-operation was 5.1%. According to the AO/OTA fracture classification, 393 (58.9%) fractures were stable, and 274 (41.1%) were unstable. The reduction was good in 538 patients (80.7%), acceptable in 14 (2.1%) and poor in 115 (17.2%) patients. The V-effect was detected in 9.4% (n=63) of all patients, and re-operation was required in 19.1% (n=12) of these. The V-effect is an iatrogenic complication during fixation of ITFF with PFN. To avoid complications of the V-effect, either constant anatomic reduction should be provided during and before implantation of PFN, or a more suitable instrument should be selected. III; retrospective study.