Proximal femoral nail antirotation II in fixation of intertrochanteric fractures: retrospective and prospective observational study

Authors

  • Arvind Kumar S. M. Department of Orthopaedics, PSG IMS and R, Coimbatore-4, Tamil Nadu, India
  • Arun Kumar B. Department of Orthopaedics, PSG IMS and R, Coimbatore-4, Tamil Nadu, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20201733

Keywords:

Intertrochanteric fractures, PFNA2, Proximal femoral nailing

Abstract

Background: Intertrochanteric fractures occur mostly in elderly patients, and the outcome may be extremely poor if there is prolonged bed-rest. The best treatment for trochanteric fracture remains controversial. Proximal femoral nail antirotation (PFNA) II has excellent fit as the design is adapted to the anatomical situation of small statured patients also. It has a medial lateral angle of 5 degrees. It has several distal locking options viz static/dynamic. Objective of this study was to observe the operating time, blood loss and fracture union in intertrochanteric fractures treated with PFNA II from the data collected from patient’s case sheets and post-operative X-rays.

Methods: 25 patients who were operated with PFNA II for unstable intertrochanteric fracture were selected using random selection and following parameters were noted from the records.

Results: The mean age of the participants is 70.72±8.55 years with range from 52 years to 89 years. The mean duration was 1.98 hours ±0.66. The median duration was 2 with interquartile range from 1.5 to 2.5 hours. Mean blood loss was estimated to be 390 ml±62.78. The median blood loss was 370 ml with interquartile range from 360 to 420 ml.

Conclusions: The PFNA II is an ideal implant for unstable intertrochanteric fracture since stable intramedullary fixation can be achieved with almost 100% union in the studied population.

Author Biography

Arvind Kumar S. M., Department of Orthopaedics, PSG IMS and R, Coimbatore-4, Tamil Nadu, India

Professor of Orthopaedics

References

Babhulkar S. Management of trochanteric fractures. Indian J Orthopaedics. 2006;40(4):210.

Rockwood C, Green D, Bucholz R. Rockwood and Green’ fractures in adults, Philadelphia: Lippincott Williams and Wilkins; 2006.

Singh A, Thong G, Laloo N, Singh A, Singh S. Management of trochanteric fractures. Indian J Orthopaedics. 2006;40(2):100.

Cooper A. Fractures and Dislocations of Joints.10th ed. London: 1839.

Bick E. Source Book of Orthopaedics. New York: Hafner; 1968.

Moore H. Treatment of intertrochanteric fractures of femur. JBJS. 1983;65:262-7.

Schumpelick W, Jantzen OM. A new principle in orthopaedic treatment of trochanteric fractures of femur. J Bone Joint Surg Am. 1955;37(4):693-8.

Whitmann R. A new method of treatment for fractures of the neck of the femur, together with remarks on coxavara. Ann Surg. 1902;36:746.

Massie WK. Extracapsular fractures of the hip treated by impaction using a sliding nail - plate fixation. Clin Orthop. 1962;22:180-202.

Jewet. One-piece angle nail for trochanteric fractures. JBJS. 1941;23:803.

Capener N. The treatment of pertrochanteric fractures. JBJS Br. 1957;39(3):436-7.

Taylor MN, Janzen J. Internal fixation for intertrochanteric fractures. JBJS Am. 1944;26(4):707-12.

Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Ach Surg. 1949;58:853-66.

Boyd H, Anderson LD. Management of unstable trochanteric fractures. Surg Gynecol Obstrtrics. 1961;55:853-63.

Bendo JA, Weiner LS, Strauss E. Collapse of interochanteric hip fractures fixed with sliding screws. Orthop Rev. 1944;30-7.

Dimon JHJC. Unstable intertrochanteric fravtures. JBJS Am. 1967;49(3):440-50.

Harrington KJ. The management of communitaed unstable intertrochanteric fracture. JBJS Am. 1973;55(7):1367-76.

Sarmiento A. Intertrochanteric fractures of femur. JBJS. 1995;75(3):90-2.

Ara D, Newman NP. Unstable intertrochanteric fracture of femur. JBJS Br. 1993;75(3):445-7.

Gargan MGR, Simpson A. How effective are osteotomies for unstable intertrochanteric fractures. JBJS BR. 1994;76(5):789-92.

Parker MJ, Hando HH, Bhargara A. Conservative versus Operative treatment for hip fractures.

The use of ender’s pin in extra capsular fractures of hip. JBJS. 1981;63;14-28.

Kosygan KP. The gotfried percutaneous compression plate compared with conventional classical hip screw fixation of intertrochanteric fractures of hip. JBJS. 2002;84(1):19-22.

Gotfried Y. Percutaneous compression plating of pertrochanteric hip fractures. J Orthop Trauma. 2000;14(7):490-5.

Medoff RM. A new device for fixation of unstable pertrochanteric fracture of the hip. JBJS Am. 1911;73(8);1192-9.

Lunsjo K, Ceder L, Stigsson L, Hauggaard A. One-way compression along the femoral shaft with the Medoff sliding plate: the first European experience of 104 intertrochanteric fractures with a 1 year follow-up. Acta Orthop Scand. 1995;66:343-6.

Watson JM. Comparison of the compression hip screw with the med off sliding plate for intertrochanteric fractures. Clin Orthop. 1998;(348):79-86.

Janzing HM. Percutaneous compression plate verses DHS in treatment of pertrochanteric hip fracture. J Trauma. 2002;52:293.

Hardy DC. Sloted ontramedullary hip screw nail reduces proximal mechanical unloading. Climorthprelat Res. 2003;406:176.

Karn NK, Singh GK, Singh MP. Comparison between external fixation and sliding hip screw in the management of trochanteric fracture of femur. JBJS Br. 2006;88:1347-50.

Yechielgotfried. Integrity of the lateral femoral wall in intertrochanteric hip fracture an important predictor of reoperation. IBJS. 2007;89:2552-3.

Downloads

Published

2020-04-22

Issue

Section

Original Research Articles