Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients

Abstract

A prospective study is presented of 87 unstable intertrochanteric fractures treated with the proximal femoral nail anti-rotation (PFNA) with a follow-up of one year. Of the patients 76% were female. The average age was 75.3 years. The fracture was treated by closed reduction and intramedullary fixation. Pre-injury activity level was recovered in 77% of the patients. Fractures united in all patients. Mechanical failure and cut-out were not observed. A technical problem related to the mismatch of the proximal end of the nail was observed in 11 cases. Nine patients presented with thigh pain due to the redundant proximal end of the nail. The results of the PFNA were satisfactory in most elderly Chinese patients. However, the proximal end of the nail was not matched with the specific anatomy of some short elderly patients. Further modifications of the nail are necessary for the elderly Chinese population.

Pelvic Migration of Lag Screw Following Fixation of an Intertrochanteric Femur Fracture with Proximal Femoral Nail

“…Postoperative reduction and position of the lag screw were normal however osteoporosis was not evaluated. Jin et al (13) reported a case series of 87 patients with no failure of fixation. Baumgaertner et al (21) in their study determined the ideal screw position and tip apex distance.…”

“…Reported complications are cut-out, medial migration of the lag screw, perforation of the femoral head, malunion in varus position, nonunion, avascular necrosis, implant failure, neurovascular injuries and stress fracture distal to the nail. The most common complication is the cut-out of the lag screw from the femoral head in varus malunions or nonunions (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Less common complications of proximal femoral nails are pelvic or lateral migration of the lag screw and perforation of the sigmoid colon.…”

“…After 2000's proximal femoral nails have been revised and, because of their biomechanical advantages, preferred very commonly especially in the unstable hip fractures with medial calcar discontinuity. However studies reporting complications related with this technique started to come out with the common use of these implants (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Reported complications are cut-out, medial migration of the lag screw, perforation of the femoral head, malunion in varus position, nonunion, avascular necrosis, implant failure, neurovascular injuries and stress fracture distal to the nail.…”

Management of Intertrochanteric Fracture of Femur with Proximal Femoral Nailing

“…38% of patients required blood transfusion. W.M Gadegone et al 29 in their study reported that 3 patients (3%) required post operative blood transfusion.…”

“…The most widely used extramedullary implant-Dynamic Hip Screw {DHS}-seems to have a biomechanical disadvantage when compared with Intramedullary devices because the load bearing in Proximal femur is predominantly shared by the calcar. Intramedullary devices such as the Proximal femoral nail {PFN}, are more stable under loading with shorter lever arm, so the distance between hip joint & the nail is reduced compared with that of a plate, thus diminishing the deforming forces across the implant 4 major biomechanical innovations to overcome the limitations of the DHS & Gamma nail The addition of the 6.4 mm anti-rotation hip pin to reduce the incidence of implant cut-out & the rotation of the cervico-cephalic fragments The smaller diameter & fluting of the tip of the nail, specially designed to reduce stress forces below the implant & therefore the incidence of lowenergy fracture at the tip. The greater implant length, smaller valgus angle & setting of this angle at a higher level (11 cm from the proximal end) The more proximal positioning of the distal locking, to avoid abrupt changes in stiffness of the construct.…”