scholarly journals Biomechanical comparison of medial sustainable nail and proximal femoral nail antirotation in the treatment of an unstable intertrochanteric fracture

2020 ◽  
Vol 9 (12) ◽  
pp. 840-847
Author(s):  
Shaobo Nie ◽  
Ming Li ◽  
Hui Ji ◽  
Zhirui Li ◽  
Wenwen Li ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Torsional Stiffness ◽  
Proximal Femoral Nail ◽  
Axial Stiffness ◽  
Intertrochanteric Fractures ◽  
Loading Test ◽  
Cyclic Loading Test ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
The Mean

Aims Restoration of proximal medial femoral support is the keystone in the treatment of intertrochanteric fractures. None of the available implants are effective in constructing the medial femoral support. Medial sustainable nail (MSN-II) is a novel cephalomedullary nail designed for this. In this study, biomechanical difference between MSN-II and proximal femoral nail anti-rotation (PFNA-II) was compared to determine whether or not MSN-II can effectively reconstruct the medial femoral support. Methods A total of 36 synthetic femur models with simulated intertrochanteric fractures without medial support (AO/OTA 31-A2.3) were assigned to two groups with 18 specimens each for stabilization with MSN-II or PFNA-II. Each group was further divided into three subgroups of six specimens according to different experimental conditions respectively as follows: axial loading test; static torsional test; and cyclic loading test. Results The mean axial stiffness, vertical displacement, and maximum failure load of MSN-II were 258.47 N/mm (SD 42.27), 2.99 mm (SD 0.56), and 4,886 N (SD 525.31), respectively, while those of PFNA-II were 170.28 N/mm (SD 64.63), 4.86 mm (SD 1.66), and 3,870.87 N (SD 552.21), respectively. The mean torsional stiffness and failure torque of MSN-II were 1.72 N m/° (SD 0.61) and 16.54 N m (SD 7.06), respectively, while those of PFNA-II were 0.61 N m/° (SD 0.39) and 6.6 N m (SD 6.65), respectively. The displacement of MSN-II in each cycle point was less than that of PFNA-II in cyclic loading test. Significantly higher stiffness and less displacement were detected in the MSN-II group (p < 0.05). Conclusion The biomechanical performance of MSN-II was better than that of PFNA-II, suggesting that MSN-II may provide more effective mechanical support in the treatment of unstable intertrochanteric fractures. Cite this article: Bone Joint Res 2020;9(12):840–847.

scholarly journals Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

2021 ◽  
Author(s):  
OP Jamshad ◽  
Jacob Mathew ◽  
Raju Karuppal
Keyword(s):  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Biological Reduction ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Shaft Angle ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

scholarly journals Results of sagittaly unstable intertrochanteric fractures managed by dual reduction technique

2019 ◽  
Vol 5 (4) ◽  
pp. 582
Author(s):  
Anoop Kalia ◽  
Gaurav Saini ◽  
Isha Sharma ◽  
Sagar Kadam
Keyword(s):  
Activity Level ◽  
Proximal Femoral Nail ◽  
Proximal Fragment ◽  
Intertrochanteric Fractures ◽  
Distal Fragment ◽  
Radiological Outcome ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
The Mean ◽  
Mean Time

<p class="abstract"><strong>Background:</strong> We evaluated the functional and radiological outcome of sagittally unstable intertrochanteric fractures reduced by dual technique consisting of a crutch placed posteriorly over distal fragment and pushing the flexed proximal fragment by ramrod anteriorly over a period of 12 months.</p><p class="abstract"><strong>Methods:</strong> A fracture was defined as sagittally unstable intertrochanteric fracture when posterior sagging of distal fragment and flexion of proximal fragment worsens after routine maneuvers for closed reduction. Out of the 80 intertrochanteric fractures treated from February 2018 to April 2019, 16 hips had sagittal instability and after reduction were treated with proximal femoral nail (Stryker Trauson) in some patients and DePuy Synthes proximal femoral nail PFNA in remaining patients. These 16 patients were followed up for a period of 1 year and functional and radiological outcome was noted.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 16 patients, 10 were males and 6 were females. The mean age was 68.2 years. According to the A.O classification out of the 16 patients, 7, 5 and 4 patients were classified as A1.3, A2.1, and A2.2 or more. The mean time from injury till surgery was 4.6 days. The mean surgical time was 45.8 minutes. The mean time for radiological union was 22.4 weeks. The mean pre injury activity level was 4.2 while the mean final activity level was 3.8 (1-5) according to modified Koval activity index.</p><p class="abstract"><strong>Conclusions:</strong> Anatomical reduction followed by rigid internal fixation is the key to success in intertrochanteric fractures. </p>

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

2020 ◽  
Vol 6 (3) ◽  
pp. 593
Author(s):  
Arvind Kumar S. M. ◽  
Arun Kumar B.
Keyword(s):  
Blood Loss ◽  
Intertrochanteric Fracture ◽  
Interquartile Range ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
X Rays ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals Finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jian Chen ◽  
Jian-xiong Ma ◽  
Ying Wang ◽  
Hao-hao Bai ◽  
Lei Sun ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Internal Fixation ◽  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Intertrochanteric Fractures ◽  
Element Analysis ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Proximal Femoral Nail Antirotation

Abstract Background More elderly patients are suffering from intertrochanteric fractures. However, the choice of internal fixation is still controversial, especially in the treatment of unstable intertrochanteric fracture; thus, previous implants continue to be improved, and new ones are being developed. The purpose of our study was to compare the biomechanical advantages between the zimmer natural nail (ZNN) and proximal femoral nail antirotation-II (PFNA-II) in the treatment of elderly reverse obliquity intertrochanteric fractures. Methods A three-dimensional finite element was applied for reverse obliquity intertrochanteric fracture models (AO31-A3.1) fixed with the ZNN or PFNA-II. The distribution, peak value and position of the von Mises stress and the displacement were the criteria for comparison between the two groups. Results The stresses of the internal fixation and femur in the ZNN model were smaller than those in the PFNA-II model, and the peak values of the two groups were 364.8 MPa and 171.8 MPa (ZNN) and 832.3 MPa and 1795.0 MPa (PFNA-II). The maximum amount of displacement of the two groups was similar, and their locations were the same, i.e., in the femoral head vertex (3.768 mm in the ZNN model and 3.713 mm in the PFNA-II model). Conclusions The displacement in the two models was similar, but the stresses in the implant and bone were reduced with the ZNN. Therefore, the ZNN implant may provide biomechanical advantages over PFNA-II in reverse obliquity intertrochanteric fractures, as shown through the finite element analysis. These findings from our study may provide a reference for the perioperative selection of internal fixations.

OUTCOME ANALYSIS OF PROXIMAL FEMORAL NAIL IN MANAGEMENT OF UNSTABLE INTERTROCHANTERIC FRACTURES

2021 ◽  
pp. 55-56
Author(s):  
Anshul Khare ◽  
Shailandra Pandey ◽  
Aman Agrahari ◽  
Abhishek Pathak ◽  
Sanjiv Gaur
Keyword(s):  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Outcome Analysis ◽  
Intertrochanteric Fractures ◽  
Average Hospital ◽  
Incision Length ◽  
Femoral Nail ◽  
The Mean ◽  
Mean Time

There is no perfect implant for intertrochanteric fractures. Nowadays Proximal Femoral Nail (PFN) is getting popular in these fractures. In this study we tried to nd and analyse the outcome of using PFN in 20 cases of unstable intertrochanteric fractures which were operated at our centre and completed the follow up till 6 months. These patients were analysed on various intra-operative and post-operative parameters. Functional assessment was done using Harris Hip Score. The mean age of patients in our study was 64 years. Average incision length was around 6.5cm and mean blood loss was 97ml. Average surgery duration was 71 minutes while average hospital stay was 18.1 days. Mean time to union was 14.9 weeks. All cases have achieved union. Varus malalignment was observed in one case. Harris Hip Score showed excellent results in 60% cases and good results in 30% cases. Our study indicates that PFN is a good implant for xation of unstable intertrochanteric fractures. However it superiority over other implants can only be conrmed with larger comparative studies.

scholarly journals Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis

2018 ◽  
Vol 4 (6) ◽  
pp. 945
Author(s):  
C. Joney Mandice ◽  
Raship Khan ◽  
Heber Anandan
Keyword(s):  
Functional Outcome ◽  
Hip Fractures ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Femur Fractures ◽  
Efficient Management ◽  
Femoral Nail ◽  
Early Return ◽  
Unstable Intertrochanteric Fracture

<p class="abstract"><strong>Background:</strong> Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.</p><p class="abstract"><strong>Methods:</strong> In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.</p><p class="abstract"><strong>Conclusions:</strong> In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.</p>

AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

2021 ◽  
Vol 15 (10) ◽  
pp. 2616-2618
Author(s):  
Zamir Hussain Tunio ◽  
Rizwan Ali Jhatiyal ◽  
Muhammad Azeem Akhund ◽  
M. Kashif Abbasi ◽  
S. Muhammad Ali ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Psychiatric Disease ◽  
Unstable Fracture ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Intramedullary Device ◽  
Unstable Intertrochanteric Fracture ◽  
Proximal Femoral Nail Antirotation

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

scholarly journals Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients§

2015 ◽  
Vol 9 (1) ◽  
pp. 456-459 ◽  
Author(s):  
G.N. Kiran Kumar ◽  
Gaurav Sharma ◽  
Kavin Khatri ◽  
Kamran Farooque ◽  
Devendra Lakhotia ◽  
...  
Keyword(s):  
Operative Time ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Tip Apex Distance ◽  
The Mean ◽  
Postoperative Fracture ◽  
Fracture Stability

Introduction:Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures.Materials and Methods:We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement.Results:The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain.Conclusion:We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications.

scholarly journals Osteoporotic Intertrochanteric Fractures in the Elderly Managed with Proximal Femoral Nail Antirotation-The Functional Outcome

2021 ◽  
Author(s):  
SPS Gill ◽  
Ankit Mittal ◽  
Manish Raj ◽  
Satosh Singh ◽  
Ajay Rajpoot ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Functional Evaluation ◽  
Intertrochanteric Fractures ◽  
Radiological Outcome ◽  
Femoral Nail ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results with Proximal Femoral Nail Antirotation (PFNA). Aim: To evaluate the functional and radiological outcome of reduction and fixation of these fractures with PFNA. Materials and Methods: This prospective interventional study was conducted from december 2015 to november 2018. A total of 62 patients of more than 50 years of age with intertrochanteric fracture were managed with internal fixation using PFNA. All the pateints were evaluated with respect to the mean operative time, blood loss. Fluoroscopy exposure, time to union and development of any complication. The statistical analysis involved calculation of the mean and Standard Deviations (SD) of above parameters which was done using the Microsoft excel chart sheet. Functional evaluation was done using the Harris Hip Score (HHS). Results: A total of 62 patients with age ranging from 54 to 94 years (mean 78.2, SD 09.11) were evaluated. The mean duration of follow-up was 14.3 months. The average operative time, the mean blood loss and the average fluoroscopy time were 61.4 (range 45-90 minutes, SD 11.6) minutes, 103.9 (range 60-200 mL, SD 36.4) mL and 74.0 (range 41 to 98, SD 13.5) seconds respectively. About 100% union rate with the average time to union being 16.1 (SD 3.3) weeks and ranging from 12 weeks to 24 weeks was reported. Varus collapse and limb shortening >1 cm were observed in 3 patients. The average HHS at the end of study showed a mean value of 82.8 (SD 8.6) and ranged from 65 to 94 with 46 (74.2%) patients having excellent to good outcome. Conclusion: Owing to easy insertion, reduced operative time and blood loss, stable fixation, less complications and good functional and radiological outcome, PFNA can prove to be an implant of choice for the management of intertrochantric fractures of the femur.

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