Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures

Abstract

Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20–94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11–31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.

The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points

“…We got satisfactory results with PFNA-2, and there was no considerable difference between 2 groups in terms of functional outcome. e varus collapse was seen in 12% [18], 5.8% [21], and 4.9% [22] of cases in previous studies. We got 15% cases with varus collapse with screw back out in the lateral entry group.…”

“…PFNA has been advised in elderly patients, and studies have found it to be a better implant and has given satisfactory functional and radiological results with minimal complications [18][19][20]. We got satisfactory results with PFNA-2, and there was no considerable difference between 2 groups in terms of functional outcome.…”

“…Out of 88% patients with neck shaft angle >120°, 12% had varus collapse. In a study by Radaideh et al [18], 3 out of 4 patients with a neck shaft angle difference of more than 10°in the lateral entry group had screw back out. ese three patients had varus reduction (<125°) of fracture which eventually led to loss of reduction and screw back out.…”

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

“…In the aged population, intertrochanteric fractures, leading to severe functional impairments, are one of the most frequent fractures; besides, it has become a severe health issue due to the rapid increase in the aged population in recent years [1][2][3][4]. Some studies reported that the annual incidence of hip fractures exceeds 320,000 cases in North America, and by 2050, this number is projected to rise to 6 million with an average annual mortality rate of more than 20% for hip fractures and intertrochanteric fractures; besides, in 2011, 316,000 hip fracture patients in the United States were hospitalized for $ 4.9 billion, while in the United Kingdom, Wales and Northern Ireland, national health services for hip fracture patients cost up to £ 1 billion [5].…”

“…PFNA has a large area of spiral blade, which can achieve tighter bone compaction and femur alignment than traditional screws, providing optimal anchoring and stability for intertrochanteric fractures, thus effectively preventing femoral head/neck rotation and the varus collapse, especially in patients with osteoporosis [9][10][11]. Indeed, more research 4 works related to femoral intertrochanteric fractures have demonstrated that PFNA is associated with smaller incisions, lower complication rates, and shorter length of stay compared to dynamic hip screws [2]. In addition, InterTAN nail, as another type of intramedullary fixation, uses an integrated interlocking lag nail system in which the main tension screw and the compression screw are trapezoidal in outline.…”