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

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

10.53350/pjmhs2115102616 ◽

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

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201733 ◽

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

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.

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

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/42425.14499 ◽

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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Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203721 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1001

Author(s):

Mayur Chopra ◽

Sanjay Kumar Srivastava ◽

Sumit Kumar ◽

Deepak Kumar Mishra

Keyword(s):

Weight Bearing ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Radiological Outcome ◽

Neck Length ◽

Neck Shaft Angle ◽

Femoral Nail ◽

Shaft Angle ◽

Tip Apex Distance

Background: Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.Methods: 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.Results: The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593Conclusions: With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.

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

Bone and Joint Research ◽

10.1302/2046-3758.912.bjr-2020-0284.r1 ◽

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.

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Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i8.36401 ◽

2021 ◽

Vol 12 (8) ◽

pp. 125-129

Author(s):

Pratyenta Raj Onta ◽

Dilip C Agarwal ◽

Upendra Jung Thapa ◽

Pabin Thapa ◽

Krishna Wahegoankar ◽

...

Keyword(s):

Blood Loss ◽

Weight Bearing ◽

Invasive Procedure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Femoral Nail ◽

The Mean ◽

Proximal Femoral Nail Antirotation ◽

A Prospective Study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1468-3 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

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.

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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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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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