J Korean Fract Soc.  2013 Oct;26(4):305-313. 10.12671/jkfs.2013.26.4.305.

Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures

• Kim JH
• Shon OJ

• KMID: 2183832
• DOI: http://doi.org/10.12671/jkfs.2013.26.4.305

Abstract

PURPOSE
To compare the results between Proximal femoral nail antirotation II (PFNA II) and Zimmer natural nail Asia type (ZNN) for the treatment of stable intertrochanteric fractures.
MATERIALS AND METHODS
Between September 2011 and September 2012, 40 consecutive patients with stable intertrochanteric femoral fractures were treated with PFNA II or ZNN. We reviewed 20 cases of PFNA II and 20 cases of ZNN prospectively. We evaluated the operation time, amount of bleeding, mean hospital day, and capability of mobility and function using 'mobility score of Parker and Palmer' and 'social score of Jensen'. We also evaluated the reduction state by the Fogagnolo, Cleveland index, change of tip and apex distance (TAD), sliding distance of cervical screw, change of neck shaft angle and bone union time.
RESULTS
There were no significant differences between the groups treated with PFNA and ZNN. Both groups showed good clinical results. PFNA showed less TAD change and ZNN showed a shorter sliding distance of cervical screw, but they were not statistically different. The bone union time was approximately 13 weeks in both groups.
CONCLUSION
PFNA and ZNN produced good clinical and radiologic results in the treatment of stable intertrochanteric fractures. There were no significant differences between the groups. Both implants provide good stability and union, so we can conclude that they are both suitable for the treatment of stable intertrochanteric fractures.

Keyword

Femur; Intertrochanteric fracture; Proximal femoral nail anti-rotation; Zimmer natural nail

MeSH Terms

Femoral Fractures
Femur
Hemorrhage
Hip Fractures*
Humans
Prospective Studies

Figure

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  Fig. 1 Photographs of PFNA II (Proximal femoral nail antirotation II).

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  Fig. 2 Photograph of ZNN (Zimmer natural nail).

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  Fig. 3 For the Cleveland index, the femur head is divided into nine zones in the axial view to classify the position of the cervical screw.

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  Fig. 4 (A) Immediate postoperative radiographs show anatomical reduction with PFNA II (proximal femoral nail antirotation II; drawing a dotted line and a full line to measure changes in tip and apex distance [TAD]). (B) Postoperative 12 weeks radiographs show minimal changes in TAD and a well united fracture site with PFNA II.

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  Fig. 5 (A) Immediate postoperative radiographs show anatomical reduction with ZNN (Zimmer natural nail; a full line to measure the sliding distance of the cervical screw). (B) Postoperative 13 weeks radiographs show minimal sliding of the cervical screw and a well united fracture site with ZNN.

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