The Proximal Femur Nail Antirotation: An Identifiable Improvement in the Treatment of Unstable Pertrochanteric Fractures?

Abstract

This study shows that osteosynthesis with the PFNA does not improve the position of the implant in the femoral head compared with the PFN. However, the risk of a secondary complication and the necessity of a late reoperation are significantly higher in patients treated with a PFN compared with patients treated with a PFNA.

Comparison of Two Types of Proximal Femoral Nails in the Treatment of Intertrochanteric Femur Fractures

“…The results were similar when the position of the implant in the femoral head was compared between nail types, but the risk of complications and the need for secondary surgery were higher in the PFN group than in the PFNA group. [5] In our study, the risks of secondary surgery and screw cut-out did not differ between the groups.…”

“…[1,2] Hip nailing, which is associated with short surgery time, stable fixation, and early postoperative mobilization, is the preferred osteosynthetic method used to treat elderly patients with ITF. [3][4][5][6][7][8][9][10][11][12] data were collected from charts and the outcomes of the most recent postoperative follow-up visits.…”

Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

“…Proximal femoral nail antirotation, like other intramedullary devices for treating patients with unstable peritrochanteric fractures, has allowed a rapid minimally invasive approach with minimal surgical trauma and provided stable fixation allowing early mobilization with full weightbearing [13,42]. The major concern of this implant, however, is the impingement of the nail on the proximal lateral cortex that can cause lateral wall fracture and/or displacement of the reduced fracture.…”

“…Additionally, peri-and postoperative complications, need for transfusion, duration of surgery, fluoroscopy time, time to mobilization, time to discharge, and plain radiography data were all collected and recorded in detail. Potential complications were distinguished as (1) major: cutout, breakage, or migration of the implant, reoperation for any reason, pulmonary embolism, acute coronary infract, acute respiratory distress; and (2) minor, including wound healing disturbances, superficial wound infection, urinary tract infection, and superficial vein thrombosis [13]. Hip function was estimated with the Harris hip score [16].…”

“…Furthermore, given controlled impaction of the metaphyseal fracture zone, immediate full weightbearing is allowed. Despite the fact that PFNA provides high union rates with low major complication rates [13,14,42], it has been associated with lateral cortex impingement [40] that causes lateral cortex fracture and fracture displacement during insertion. The round profile of the nail creates pressure to the lateral wall and the headneck fragment (Fig.…”