DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192687

An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II

Hemeshwar Harshwardhan, Shubhanshu Jain, Manish Sharma

Abstract


Background: Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition & thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.

Methods: Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.

Results: The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.

Conclusions: Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade. 


Keywords


Intertrochanteric, Intramedullary, PFNA II, Nailing

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References


Lenich A, Fierlbeck J, Al-Munajjed A, Dendorfer S, Mai R, Füchtmeier B, et al. First clinical and biomechanical results of the Trochanteric Fixation Nail (TFN). Technol Health Care. 2006;14(4-5):403–9.

Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury. 2006;37(10):984–9.

Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. 1st ed. Berlin, Heidelberg, Germany, New York, NY, USA: Springer-Verlag; 1990.

Orthopaedic Trauma Association Committee for Coding and Classification Fracture and dislocation compendium. J Orthop Trauma. 1996;10(Suppl. 1):1-154.

Liu M, Yang Z, Pei F, Huang F, Chen S, Xiang Z. A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures. Int Orthop. 2010;34(3):323–8.

Simmermacher RKJ, Bosch AM, Van Der Werken C. The AO/ASIF-proximal femoral nail (PFN): A new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30(5):327–32.

Schipper IB, Bresina S, Wahl D, Linke B, Van Vugt AB, Schneider E. Biomechanical evaluation of the proximal femoral nail. Clin Orthop Relat Res. 2002;(405):277–86.

Sommers MB, Roth C, Hall H, Kam BCC, Ehmke LW, Krieg JC, et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma. 2004;18(6):361–8.

Penzkofer J, Mendel T, Bauer C, Brehme K: Treatment results of pertrochanteric and subtrochanteric femoral fractures: a retrospective comparison of PFN and PFNA. Unfallchirurg. 2009;112(8):699-705.

Zeng C, Wang YR, Wei J, Gao SG, Zhang FJ, Sun ZQ, et al. Treatment of trochanteric fractures with proximal femoral nail antirotation or dynamic hip screw systems: a meta-analysis. J Int Med Res. 2012;40(3):839-51.

Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, et al. Treatment of trochanteric fractures with the proximal femoral nail antirotation (PFNA) nail system – report of early result. Bull NYU Hosp Jt Dis. 2008:66(4):276-9.

Sahin S, Ertürer E, Oztürk I, Toker S, Seçkin F, Akman. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation (PFNA) in the treatment of unstable intertrochanteric femoral fractures. Acta Orthop Traumatol Turc. 2010;44(2):127-34.

Mora A, Marimon. PFNA in treatment of femoral fractures. Bone Joint J Orthop Proceedings. 2011;93(2):136.

Aguado-Maestro I, Escudero-Marcos R, Garcia-Garcia JM, Alonso-Garcia N, Perez-Bermejo DD, Aguado-Hernandez HJ, et al. Results and complications ofpertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nailantirotation) in 200 patients. Rev Esp Cir Ortop Traumatol. 2013;57:201–7.

Liu Y, Tao R, Liu F, Wang Y, Zhou Z, Cao Y, et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. Elsevier Ltd; 2010;41(8):810-7.

Kashid MR, Gogia T, Prabhakara A, Jafri MA, Shaktawat DS, Shinde G. Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures. Int J Resorthop. 2016;2(4):354-8.