Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series

Abstract

Background: Combined ipsilateral femoral neck and shaft fractures are an uncommon type of fractures. A number of different implant options are available for the management of this injury. Two-device procedures were suggested because of the higher rate of malunion by single-device treatment. However, surgical treatment using a cephalomedullary nail is still an alternative option that provides better mechanical advantage and minimal invasion. This study details the technique of treating these pattern fractures with proximal femoral nail anti-rotation II (PFNA-II) to achieve an acceptable reduction in both fracture sites. Methods: Ten cases of ipsilateral femoral neck and shaft fractures under reduction by PFNA II were included and reviewed. A saw-bone model was also utilized to perform the detailed technique of reduction and fixation of PFNA II. Results: Under the special technique by using the PFNA II, all ten cases achieved optimal reduction and alignment of both fracture sites in intra-operative fluoroscopy. There was no intra-operative complication noted. After 6 months of follow-up, radiography revealed proper alignment and well union of the fractures. Conclusions: Fixation of ipsilateral femoral neck and shaft fractures with a single construct provides advantages of good biomechanical function, minimal invasion, reduced blood loss, and less operation time when comparing to two-device fixation. Thus, if acceptable reduction could be achieved, fixation by one PFNA II was a good alternative choice for this injury pattern.

Fractures around Trochanteric Nails: The “Vergilius Classification System”

“…The healing status of the previous EF might complicate the fracture pattern, resembling an ipsilateral femoral neck and shaft fracture. These considerations were not accepted by two research members, especially regarding the choice of the fixation device, because several reports proposed the use of a single fixation device (namely the nail) for the treatment of ipsilateral femoral neck and shaft fractures [ 28 , 29 ].…”

Clinical Efficacy of Intramedullary Fixation vs. Plate Fixation for Femoral Intertrochanteric Fractures

“…Compared with extramedullary xation, intramedullary xation holds the following advantages: the intramedullary xation system belongs to central xation, which is more in line with the biomechanics of the proximal femur and can better perform femoral anatomical reduction, improving the stability of internal xation; the operation is simple and convenient with a short operation time, and the injury of blood vessels and nerves may be greatly avoided [7] [8] [9] ; the surgical incision is small, which protects the blood supply of the fracture end to the greatest extent and is conducive to fracture healing. The postoperative incision healing time is shorter, and the postoperative recovery is faster [10] [11] [12] ; early mobility can greatly reduce the occurrence of postoperative complications, and hip joint functional exercises may be performed more quickly [13] [14] ; effects in long-term operation is reliable, and the failure rate is relatively low with the passage of time [15] [16] [17] .…”

Clinical Efficacy of Intramedullary Fixation vs. Plate Fixation for Femoral Intertrochanteric Fractures

“…Compared with extramedullary xation, intramedullary xation holds the following advantages: the intramedullary xation system belongs to central xation, which is more in line with the biomechanics of the proximal femur and can better perform femoral anatomical reduction, improving the stability of internal xation; the operation is simple and convenient with a short operation time, and the injury of blood vessels and nerves may be greatly avoided [7] [8] [9] ; the surgical incision is small, which protects the blood supply of the fracture end to the greatest extent and is conducive to fracture healing. The postoperative incision healing time is shorter, and the postoperative recovery is faster [10] [11] [12] ; early mobility can greatly reduce the occurrence of postoperative complications, and hip joint functional exercises may be performed more quickly [13] [14] ; effects in long-term operation is reliable, and the failure rate is relatively low with the passage of time [15] [16] [17] .…”