Intramedullary Proximal Femoral Nailing for Unstable Peritrochantric Fracture: A Prospective Study

Abstract

Trochanteric fracture id one of the commonest fractures in Orthopaedics and also among the most devastating injuries of the elderly. The incidence of this fracture increases with advancing age. Around 50% of the Peri-trochanteric variant of these fractures, are of the unstable type. PFNA2 deploys a helical blade which provides compressibility and an additional rotation control at the fracture site.The aim of this study is to assess the effectiveness of Intra-medullary xation of unstable peri-trochanteric fractures with inter-locking proximal femoral nail PFNA2, in a prospective study. This study was done in Department of Orthopaedics, Chettinad Hospital and Research institute, Kelambakkam, Chengalpattu district, Tamilnadu and was spread over 4 years from Jan 2017 to December 2020 with minimum follow-up period of 12 months. 66 patients participated in this study. Harris Hip Score was used to assess the functional outcome. The Harris Hip Score, mean at 6 months was 75.35, which improved to 82.02 by 12 months of follow-up. With regard to our complications 4 patients had a superior cut out of helical screw, which required re-operation by bipolar hemiarthroplasty of the cemented variant. 9 patients had a varus deformity of 10-12 degrees. Abductor lurch was noted in 11 patients. Supercial-wound infection occurred in 8 patients and deep wound infection, requiring surgical irrigation occurred in 3 patients. In conclusion, PFNA2 has better stability, better rotatory stress shielding, superior compaction at fracture site, less blood loss, shorter operation time, less radiation exposure and better clinico-radiological outcomes. PFNA2 is a good implant choice to tackle the complex problems encountered in displaced unstable trochanteric fractures