Hip Pelvis.  2012 Jun;24(2):124-132. 10.5371/hp.2012.24.2.124.

Mid-term Results of Patients with Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation

• Choo SK
• Oh HK
• Woo SJ

• KMID: 1439101
• DOI: http://doi.org/10.5371/hp.2012.24.2.124

Abstract

PURPOSE
To evaluate the mid-term results of patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) in the elderly.
MATERIALS AND METHODS
Between March 2008 and February 2010, 93 patients with intertrochanteric femoral fractures were treated with PFNA. Of these patients, 43 could be followed for a mean of 19.1 months (range, 12-33 months). The mean age was 77.3 years (range, 62-93 years) and there were 6 males and 37 females. According to the AO/OTA classification, there were 14 cases of A1, 25 cases of A2, and 4 cases of A3. Radiological outcomes were assessed at the union period along with the sliding distance of the antihelical blade according to fracture type. Functional outcomes were assessed according to the Chanley hip pain scoring system, walking ability, and the Activities of Daily Living (ADL) index.
RESULTS
All patients, except for one with a deep infection, had complete union at 3.5 months (range, 2-6 months). Postoperative X-rays showed a good or acceptable reduction in 43 cases(100%), and an ideal blade position without significant differences according to the fracture type. The mean sliding length of the blade was 6.1 mm (range, 0-21 mm) and mean Chanley hip pain score was 4.0 points (range, 0-6.0 points). 19 patients (44%) were restored to their preoperative walking ability. 22 patients(51.2%) were able to live independently without support.
CONCLUSION
The PFNA is a very effective implant in the treatment of different patterns of intertrochanteric femoral fractures. But further studies are needed focusing on a functional recovery and rehabilitation to improve postoperative clinical outcomes.

Keyword

Proximal femur; Intertrochanteric fracture; PFNA

MeSH Terms

Activities of Daily Living
Female
Femoral Fractures
Hip
Hip Fractures
Humans
Male
Nails
Walking

Figure

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  Fig. 1 Measurement of sliding using radiographs. (A) Immediate postoperative radiograph. a: total lengthat immediate postoperative state, b: distal end lengthat immediate postoperative state. (B) The last Follow up radiograph. c: total length at the last follow up, d: distal end lengthat the lastfollow up, Correction factor: c/a, Corrected follow up sliding: d/Correction factor, Result: Corrected follow up sliding - d.

• 

  Fig. 2 (A) An 80-years old female fell from a standing height and sustained an unstable left intertrochanteric hip fracture (AO31A2.2). (B) A PFNA was placed and postoperative radiograph shows good reduction and optimal blade position in femoral head. (C) Last follow-up X-ray shows complete fracture healing despite of significant sliding of helical blade.

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