J Korean Fract Soc.  2010 Oct;23(4):353-359. 10.12671/jkfs.2010.23.4.353.

Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate

• Kim TH
• Kim JO
• Lee SY
• Yun GU

• KMID: 1461491
• DOI: http://doi.org/10.12671/jkfs.2010.23.4.353

Abstract

PURPOSE
To evaluate the effectiveness of Proximal Femoral Nail Anti-rotation (PFNA) for the treatment of unstable intertrochanteric fracture comparing with Compression Hip Screw (CHS) with Trochanteric Stabilizing Plate (TSP).
MATERIALS AND METHODS
With clinical study, 43 patients who were treated surgically for unstable intertrochanteric fractures were retrospectively evaluated. One group was treated with CHS and TSP (Group 1, 22 cases) and the other was treated with PFNA (Group 2, 21 cases). By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Lag screw slippage, Neck-shaft angle change and Union time. And By retrospective medical record review, the clinical results were evaluated with the operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, walking ability change and complication.
RESULTS
There was a lower operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, lag screw slippage and neck shaft angle change in the Group 2 than in the Group 1 (p<0.05).
CONCLUSION
PFNA showed better results than CHS with TSP in operation time, estimated blood loss, amount of drainage and transfusion, lag screw slippage and neck-shaft angle change.

Keyword

Femur; Intertrochanteric fracture; Proximal femoral nail antirotation; Trochanteric stabilizing plate

MeSH Terms

Drainage
Femur
Follow-Up Studies
Hip
Hip Fractures
Humans
Medical Records
Nails
Neck
Retrospective Studies
Walking

Figure

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  Fig. 1 Photographs of real implant of TSP (Trochanteric Stabilizing Plate).

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  Fig. 2 Photographs of real implant of PFNA (Proximal Femoral Nail Antirotation).

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  Fig. 3 Cleveland index.

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  Fig. 4 (A) 73 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2. (B) Postoperative radiograph shows that good reduction and well positioned PFNA blade. (C) Postoperative 6 mons radiograph shows minimal sliding of PFNA blade and well united fracture site.

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  Fig. 5 (A) 84 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2. (B) Postoperative radiograph shows that acceptable reduction but superior positioned lag screw. (C) Postoperative 8 weeks radiograph shows cutting out of the lag screw. (D) Reoperation was done with cemented bipolar hemiarthroplasty.

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  Fig. 6 (A) 73 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2. (B) Postoperative radiograph shows that poor varus reduction and superior positioned PFNA blade. (C) Postoperative 4 weeks radiograph shows cutting out of the PFNA blade. (D) Reoperation was done with cemented bipolar hemiarthroplasty.

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