J Korean Fract Soc.  2011 Jul;24(3):217-222.

The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table

• Kim JH
• Lee SH
• Lee KC
• Cho SW

Abstract

PURPOSE
The purpose of this study is to analyze the results of intertrochanteric fractures treatment with proximal femoral nail antirotation (PFNA) without using fracture tables and thereby prevent complications.
MATERIALS AND METHODS
Forty cases of intertrochanteric fracture of 39 patients that were treated with PFNA without using fracture tables between January 2008 to December 2009 were analyzed. There were 13 males and 27 females. The mean age was 76 years old. Using AO classification, 6 cases were A1, 25 cases were A2 and 9 cases were A3. The operation was done without using fracture tables at supine position. Operation time, intraoperative bleeding were checked. For the result, Cleveland index, tip apex distance, fracture site sliding rate, change of femur neck and shaft angle were evaluated. Bone union time and complications were also estimated from the follow up radiograph. Statistics were analyzed using Independent T-test.
RESULTS
The mean operation time was 40 minutes (25 to 70 minutes) and mean intraoperative bleeding was 113 cc (40 to 250 cc). The Cleveland index was shown 94% of 5, 6, 8 and 9 zone, the tip apex distance was 12.96 mm (6 to 22 mm), the fracture sliding distance was 1.9 mm (0 to 6 mm), the change of femur neck and shaft angle was 2.5 degree (0~10 degree) and the average bone union time was 15 weeks (8 to 24 weeks). The complication include 2 cases of delayed union and 2 cases of varus deformities.
CONCLUSION
We have shortened the operation time by closed reduction methods without using the fracture tables, and the complication were minimized with using simple tools like a reduction forcep or bone hook at PFNA blade insertion.

Keyword

Femur; Intertrochanteric fracture; Proximal femoral nail antirotation (PFNA); Fracture table

MeSH Terms

Female
Femur
Femur Neck
Follow-Up Studies
Hemorrhage
Hip Fractures
Humans
Male
Nails
Supine Position
Surgical Instruments

Figure

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  Fig. 1 (A) C-arm image is checked without using fracture table preoperatively. (B) Closed reduction is done under C-arm image.

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  Fig. 2 (A) Preoperative radiograph show unstable intertrochanteric fracture of a 83 year-old female. (B) Guide wire is inserted after mannual reduction. (C, D) Fracture site is reduced by using bone hook and guide pin inserted for blade. (E) Fracture site is reduced on C-arm image satisfactory. (F) Postoperative radiograph after fixation with a PFNA. (G, H) Radiograph made 3 months postoperatively showing a bone union.

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