Functional and radiological outcome of osteosynthesis using proximal femoral nail antirotation II system in intertrochanteric femoral fractures
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210619Keywords:
Harris hip score, Intertrochanteric fractures, Intra-medullary device, PFNA-IIAbstract
Background: Intertrochanteric fractures are relatively common injuries in adults and a common source of morbidity and mortality among the elderly. Incidence of fractures is increasing because the general life expectancy of the population has increased significantly during the past few decades. Stable fixation and early mobilization is needed in these fractures to reduce the morbidity and mortality. Extra-medullary implants are biomechanically inferior in these cases. The proximal femoral nail antirotation-II (PFNA-II) is an intra-medullary nail system designed for such fractures. The purpose of this study was to assess the results and complications of PFNA-II in intertrochanteric femur fractures.
Methods: After seeking approval from institutional Ethical committee, this study was conducted on 30 patients attending our emergency department with intertrochanteric femur fractures at SKIMS Medical College Hospital Bemina, Srinagar from February 2018 to June 2019. The patients were treated with proximal femoral nail antirotation-II. Follow up was done at 2, 6, 12 and 24 weeks. The functional outcome was assessed at 6 months follow up using the Harris Hip Score.
Results: Based on the Harris hip score, 18 (60%) patients had excellent results, 10 (33%) had good results and 2 (7%) had Fair results. None of the patients had poor result. Average time to union was 12.27 weeks.
Conclusions: This study found the PFNA-II to be a versatile, easy to use and dependable implant for stable as well as unstable intertrochanteric fractures. PFNA II is distinct advance over the previous methods of treatment, though it has an initial learning curve.
References
Sadic S, Custovic S, Jasarevic M, Fazlic M, Smajic N, Hrustic A, et al. Proximal femoral nail antirotation in treatment of fractures of proximal femur. Med Arch. 2014;68(3):173.
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.
Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996;10(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 BC, 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..
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55.
Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing postoperative rehabilitation. J Bone Joint Surg Br. 2005;87:76-81.
Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res. 2013;99:377-83.
Li M, Wu L, Liu Y, Wang C. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures. J Orthop Surg Res. 2014;9:112
Li J, Xu XZ, You T, Li H, Jing JH. Early results of the proximal femoral nail antirotation-Asia for intertrochanteric fractures in elderly Chinese patients. Saudi Med J. 2014;35(4):385-90.
Aviral D, Keval PH, Shailendra S, Soni SS. Role of proximal femoral nail anti-rotation in extracapsular proximal femoral fractures. Int J Orthop Sci. 2018;4(4):84-8.
Kasha S, Rathore S, Suri HS, Swamy A, Naik GL, Mahesh SG. PFNA-II in Peritrochanteric Femur Fractures: Experiences in Osteoporotic Elderly Indians. Int J Res Rev. 2017;4:56-62.
Kumar GK, Sharma G, Khatri K, Farooque K, Lakhotia D, Sharma V, et al. Treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation II: our experience in Indian patients. Open Orthop J. 2015;9:456-9.
Kripalani S, Shelke U, Kulkarni S, Vakil S, Bhosale J, Gurucharan S. Proximal femoral nail antirotation- II with antirotation screw- treatment for stable and unstable intertrochanteric fractures in Asian patients. J Trauma Orthop Surg. 2018;13(3):2-6.
Li J, Cheng L, Jing J. The Asia proximal femoral nail antirotation versus standard proximal femoral antirotation for unstable intertrochanteric fractures in elderly Chinese patients. Orthop Traumatol Surg Res. 2015;101:143-6.
Goffin JM, Pankaj P, Simpson AH, Seil R, Gerich TG. Does bone compaction around the helical blade of a proximal femoral nail anti-rotation (PFNA) decrease the risk of cut-out? A subject-specific computational study. Bone Joint Res. 2013;2(5):79-83.
Harshwardhan H, Jain S, Sharma M. An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II. Int J Res Orthop. 2019;5(4):699-702.
Na WC, Lim CW, Lee SH. Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail. Med Biol Sci Eng. 2018;1(2):45-50.
