Treatment of intertrochanteric femur fracture in elderly patients with the proximal femoral nail antirotation: evaluation in terms of union and functional outcome
Keywords:PFNA, Intertrochateric femur fracture, Harris hip score
Background: Trochanteric fractures almost invariably occur as a result of a trivial fall involving both direct and indirect forces. Fixation in the geriatric population generally consists of weakened, osteoporotic bone; intramedullary devices (PFNA) carry an advantage over other load sharing devices by not having to depend on plate fixation with bone screws purchasing a compromised lateral cortex. The purpose of the present study is to verify the theoretical advantages of the proximal femoral nail in elderly osteoporotic patients and eventually functional outcome of the patient.
Method: A total of 30 patients with age >60 years with intertrochanteric femur fractures managed with proximal femoral nail anti-rotation for prospective study. Harris hip score had been used in our study for regular follow up and evaluation at each and every follow up visit.
Results: Average Harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 73% patients showing excellent or good outcome. And 100% fractures got united with a good component position and average time to bone healing was 14 weeks.
Conclusions: PFNA are now favored in western countries and there are multiple studies coming from that region to support this. Due to advantages of high union rate, early postoperative mobilization, and short operation time, PFNA osteosynthesis is the method of choice for surgical treatment of stable and unstable osteoporotic intertrochanteric femoral fractures.
Kaufer H. Mechanics of the Treatment of Hip Injuries. Clin Orthop. 1980;146:53 -61.
Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. A retrospective and prospective study. J Bone Joint Surg. 1979;61A:216-21.
Kaufer H, Mathews LS, Sonstegard D. Stable Fixation of Intertrochanteric Fractures. J Bone Joint Surg. 1974;56A:899-907.
Sahlstrand T. The Richards Compression and Sliding Hip Screw System in the Treatment of Intertrochanteric Fractures. Acta Orthop Scand. 1974;5:213-9.
Sarmiento A. Intertrochanteric fractures of the femur. 150 -degree-angle nail-plate fixation and earl y rehabilitation - A preliminary report of 100 cases. J Bone Joint Surg. 1963;45A:706-22.
Sarmiento A, Williams EM. The unstable intertrochanteric fracture: treatment with a valgus osteotomy and I - beam nail -plate. A preliminary report of one hundred cases. J Bone Joint Surg. 1970;52A:1309-8.
Clawson DK. Trochanteric fractures treated by the sliding screw plate fixation method. J Trauma. 1964;4:737-52.
Sadic S. Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Hip Fractures:a Retrospective Study in 113 Patients Med Arh. 2015;69(6):353-6.
Kumar GN. Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients. Open Orthopaedics J. 2015;9:456-9.
Sahin S, Ertürer E, Oztürk I, Toker S, Seçkin F, Akman S. 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.