DISTAL UNLOCKED PROXIMAL FEMORAL NAIL - A PROSPECTIVE STUDY AND REVIEW ABOUT ITS FUNCTIONAL OUTCOME AND COMPLICATIONS IN INTERTROCHANTERIC FRACTURES.

Background: Proximal femur nailing has become the treatment of choice in intertrochanteric femur fractures. There are different views regarding the use of distal locking in these fractures. It is said that the distal locking does not only provide rotational and axial stability but also improves the fracture healing ; However, reports of implant failure , implant breakage , stress fracture at nail tip or at distal screw insertion site , thigh pain ,cortical hypertrophy and difficulty in distal screw insertion are among the possible complications that can be encountered. In our study we investigated the outcome of omitting the distal screw in intertrochatric fractures. Materials and Methods: 19 patients with intertrochanteric femur fractures were treated with proximal femoral nail without distal locking. Distal locking was omitted when a tight fit of PFN was felt in the medullary canal by the operating surgeon. The results were evaluated with Modified Harris Hip Score. Results: 19 patients were followed up clinically and radiologically for 2 years. Conclusions: Distally unlocked proximal femoral Nail is an effective treatment modality with minimal complications in treatment of only STABLE intertrochantric fractures. Keywords: PFN, without distal lock, intertrochanteric fractures

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Functional and radiological outcome of osteosynthesis using proximal femoral nail antirotation II system in intertrochanteric femoral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210619 ◽

2021 ◽

Vol 7 (2) ◽

pp. 267

Author(s):

Wajahat Ahmad Mir ◽

Mohmad Nawaz Rather ◽

Rasiq Rashid

Keyword(s):

Morbidity And Mortality ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Common Source ◽

Intertrochanteric Fractures ◽

College Hospital ◽

Femur Fractures ◽

Femoral Nail ◽

Proximal Femoral Nail Antirotation

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.

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Evaluation of clinical results and complications of internal fixation of intertrochanteric femur fracture with proximal femoral nail antirotation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190531 ◽

2019 ◽

Vol 5 (2) ◽

pp. 283 ◽

Cited By ~ 1

Author(s):

Manish Raj ◽

S. P. S. Gill ◽

Akashdeep Singh ◽

Ajay Kumar Rajput ◽

Santosh Kumar Singh

Keyword(s):

Functional Outcome ◽

Varus Deformity ◽

Clinical Results ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Significant Treatment ◽

Femur Fractures ◽

Femoral Nail ◽

Proximal Femoral Nail Antirotation

Background: The purpose of the present study was to evaluate the theoretical advantages of the proximal femoral nail antirotation in cases of intertrochanteric fractures and also whether it actually alters the eventual functional outcome of the patient.Methods: The present study includes a total 30 patients with intertrochanteric femur fractures managed with proximal femoral nail antirotation between December 2014 to November 2016. In all patients similar standard physical rehabilitation therapy were followed. All complications including intra and postoperative were assessed and recorded. The patients were followed up for over 24 months. Functional outcome was assessed using the Harris hip score.Results: All of 30 cases of intertrochanteric fracture got united with good anatomical position and average time of fracture union was 14 weeks. Postoperative complications included 2 degree varus deformity (n=1, 3%), calcification at tip of greater trochanter (n=4, 13%), sensitivity over TFL (n=2, 7%), medial thigh pain (n=3, 10%). 10 patients developed femoral shortness (mean=0.22 cm, range from 0-1 cm). Average harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 22 (73%) patients showing excellent or good outcome.Conclusions: Proximal femoral nail antirotation (PFNA) represents a significant treatment option in management of intertrochanteric fractures with low complication rate.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184391 ◽

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

Background: 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’.Methods: 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.Results: 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.Conclusions: 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.

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Critical analysis of factors determining mechanical failures in proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190504 ◽

2019 ◽

Vol 5 (2) ◽

pp. 275 ◽

Cited By ~ 1

Author(s):

Karthik Ramachandran ◽

K. K. Arvind Manoj ◽

A. Vishnu Sankar

Keyword(s):

Failure Rate ◽

Mechanical Failure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Excellent Outcome ◽

Lag Screw ◽

Femoral Nailing ◽

Femoral Nail ◽

Proximal Femoral Nailing

Background: Intertrochanteric fractures are one of the commonest fractures encountered in elderly population. Though there are various implants, proximal femoral nail has been the standard choice for management of unstable fractures. Inspite of its biomechanical advantages, various complications like screw cut out, Z effect, reverse Z effect does occur in proximal femoral nailing. The aim of the study is to analyse various factors determining the mechanical failures in patients operated with proximal femoral nail.Methods: This is a prospective study conducted in our institution from June 2014 to May 2018. The study included 72 patients with unstable intertrochanteric fractures treated with proximal femoral nail. All patients were followed for average period of 2 years. Functional outcome was assessed using Harris Hip score.Results: Among the patients 33% had excellent outcome. 42% had good and 14% had fair outcome. 11% of cases ended with poor outcome. Mechanical failure rate was less in patients with positive medial cortical support (PMCS) and in patients with tip apex distance difference between antirotation screw and lag screw (TADAR -TADLS) more than 15 mm. Whereas the difference in the position of lag screw centre had no significant influence in the mechanical failure rate in our study.Conclusions: From our study we like to conclude that the fracture reduction with positive medial cortical support and the TAD difference play a major role in determining the incidence of mechanical failure in proximal femoral nailing.

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

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47653.14751 ◽

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).

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

10.36106/ijsr/8522907 ◽

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.

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INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

Journal of International Medical Research ◽

10.1177/0300060517710584 ◽

2017 ◽

Vol 45 (4) ◽

pp. 1297-1309 ◽

Cited By ~ 8

Author(s):

Hui Zhang ◽

Xianshang Zeng ◽

Nan Zhang ◽

Dan Zeng ◽

Ping Xu ◽

...

Keyword(s):

Elderly Patients ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Primary Osteoporosis ◽

Femur Fractures ◽

Femoral Nail ◽

Increased Risk ◽

Proximal Femoral Nail Antirotation ◽

Intertan Nail

Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score. Results In total, 174 patients with osteoporosis (IT, n = 86; PFNA-II, n = 88) were evaluated during a mean follow-up period of 40 months (range, 38–60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up. Conclusion The IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.

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Treatment of stable and unstable intertrochanteric fractures using proximal femoral nail and their functional assessment using modified Harris hip score

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185340 ◽

2018 ◽

Vol 5 (1) ◽

pp. 162

Author(s):

Lakshya P. Rathore ◽

Lokesh Gupta ◽

Sanjay Thakur ◽

Sandeep Vaidya ◽

Devender Sharma ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Functional Evaluation ◽

Intertrochanteric Fractures ◽

Good Reduction ◽

Non Union ◽

Femoral Nail ◽

Modified Harris Hip Score ◽

A Prospective Study

Background: Intertrochanteric fracture is common injury and is found in both elderly and the young. Proximal femoral nail (PFN) has been in widespread use for the same in the recent past. There are advocates both for and against this implant. The aim was to study the results of PFN in the treatment of intertrochanteric fractures and their functional evaluation using the modified Harris hip score.Methods: A prospective study done on 104 patients operated for intertrochanteric fractures with PFN. Patients were followed up at 6 weekly intervals and evaluated at each visit using the modified Harris hip score (HHS).Results: The study consisted of 104 patients aged from 36 to 96 years with average age of 67.8 years. Most patients belonged to 60-80 years category. Malunion was observed in three patients (2.8%) and non union was not seen in any patient. Excellent to good results were seen in 73% patients 18% patients had a fair outcome, 7.7% had poor and 2% patients had very poor outcome.Conclusions: PFN is a good implant for intertrochanteric fracture treatment that demands a sound technique and a good reduction prior to insertion. The assessment of results using HHS has been too similar to those obtained using Kyle’s criteria in the previous studies, proving its role in the same.

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Cemented versus uncemented total hip arthroplasty for failed proximal femoral nail anti-rotation fixation in patients with intertrochanteric femur fractures: 5-year results of a retrospective observational study

10.21203/rs.2.20877/v1 ◽

2020 ◽

Author(s):

Wenli Chen ◽

Mao Shuai ◽

Jinluan Lin ◽

Baomin Chen ◽

Mingdong Zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Secondary Outcome ◽

Total Hip ◽

Femur Fractures ◽

Femoral Nail ◽

Uncemented Total Hip Arthroplasty

Abstract Background: Cemented or uncemented total hip arthroplasty (CTHA or UTHA) is being increasingly performed in patients with intertrochanteric femur fractures (IFFs) who failed to be treated with proximal femoral nail anti-rotations (PFNA) fixation. The purpose of this study is to compare the clinical outcomes of CTHA or UTHA following prior failed PFNA fixation in patients with IFFs.Methods: Data from 244 patients with IFFs who underwent a conversion of PFNA to CTHA (PCA, n =120) or to UTHA (PUA, n = 124) due to pain and hip disfunction during 2008-2018 were retrospectively analysed. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The mean follow-up was 64 months (range, 57 – 71 months). The Harris hip score (HHS) was the primary outcome; the incidence of major orthopaedic complications was the secondary outcome.Results: At the final follow-up, HHS was 79.54±18.85 vs 75.26±18.27 (PCA vs PUA, p = 0.014). There were significant differences between groups regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (5.8% for PCA vs 14.5% for PUA, p = 0.025; 10.0% for PCA vs 20.1% for PUA, p = 0.027; 3.3% for PCA vs 10.5% for PUA, p = 0.028, respectively). Conclusion: The results of the study demonstrated a significant advantage with respect to HHS and major orthopaedic complication rate in favor of CTHA, as compared to UTHA in patients with a failed PFNA treatment.

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Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing plate in unstable intertrochantric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173198 ◽

2017 ◽

Vol 3 (5) ◽

pp. 936

Author(s):

Siddaram N. Patil ◽

Pandurangaiah Srinivas

Keyword(s):

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Hip Screw ◽

Mobility Score ◽

Unstable Fractures ◽

Parker Mobility Score

Background: Unstable fractures accounts for approximately 50 to 60% of all intertrochanteric fractures. Failure rates of (DHS) dynamic hip screw for unstable fracture patterns are as high as 50%. Proximal femoral nail is technically more demanding surgery and also associated with complications like implant failure, femoral shaft fracture, improper reduction, screw cut-out and non-union. This study was done to compare the results of using Trochanteric stabilization plate in addition to dynamic hip screw versus proximal femoral nail which is considered as a better implant for unstable fractures.Methods: A prospective study was conducted comparing outcomes of proximal femoral nailing versus trochanteric stabilization plate with dynamic hip screw for 44 patients with unstable intertrochanteric fractures (22 each). Harris hip scoring system and Parker mobility score was used for evaluation.Results: In our study, Average time of union in all 22 patients of PFN group was about 12 weeks while average time of union in all 22 patients of DHS with TSP group was about 14 weeks. The Harris hip score was 85.45 in DHS with TSP group while it was 84.72 in the PFN group (p=0.846). The Parker mobility score was 7.81 in the DHS with TSP group while it was 7.95 in the PFN group (p=0.728). Conclusions: Use of TSP with DHS can give good results in unstable IT fractures. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialisation of shaft and gives comparable result to PFN.

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