Hip Pelvis.  2017 Jun;29(2):104-112. 10.5371/hp.2017.29.2.104.

Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?

Affiliations
  • 1Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. kuentak@pusan.ac.kr
  • 2Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE
We evaluated the geometric discrepancies between the proximal femur in Koreans and two types of proximal femoral nail using plain radiographs.
MATERIALS AND METHODS
A total of 100 consecutive patients (38 treated with proximal femoral nail antirotation [PFNA], 62 PFNA II) with intertrochanteric fracture were retrospectively identified. The minimum follow up period was 32 months. The geometric analysis of the proximal femur was performed using preoperative true hip antero-posterior radiographs of the unaffected side, and the data were compared with the PFNA and PFNA II dimensions. Postoperative assessments were performed using postoperative radiographs for the proximal protruding length of nail tip, quality of reduction, implant position and the presence of lateral cortical impingement.
RESULTS
The geometric dimensions of the proximal femur were different between the two proximal femoral nail types. No impingement was detected in patients treated with PFNA II, whereas 13 cases of lateral impingement were observed in patients treated with PFNA. A significant association was observed between the short proximal femur and the presence of lateral cortical impingement (P=0.032) and between impingement and intraoperative reduction loss (P=0.012). Proximal protrusion of the nail tip was seen in 71 patients and no difference was observed between two groups.
CONCLUSION
Our study demonstrates that the flat lateral surface of PFNA II can avoid lateral cortical impingement, which provide better fixation for intertrochanteric fracture. However, there was still a problem associated with longer proximal end of PFNA II compared with the proximal femoral length in Korean.

Keyword

Intertrochanteric fracture; Lateral cortical impingement; Proximal femoral nail antirotation; Korean

MeSH Terms

Femoral Fractures*
Femur
Follow-Up Studies
Hip
Humans
Retrospective Studies

Figure

  • Fig. 1 This picture demonstrates the measuring method of the geometry of the proximal femur. Proximal femoral length (PFL) was the distance between the tip of the greater trochanter and the crossing point, which was made between femoral shaft axis and line drawn at 130° to the femoral shaft axis from the inferior margin of the femoral neck (central line of the proximal femur). The anteroposterior bending angle (APBA) was formed by the femoral shaft line and a line between the greater trochanteric tip and the crossing point. Arrow indicates the impingement point.

  • Fig. 2 Postoperative radiograph (A) shows anatomical mismatch between the proximal femur of the patient and proximal femoral nail antirotation (PFNA), and lateral cortical impingement (arrow). Postoperative radiograph (B) shows good alignment without lateral cortical impingement between the proximal femur of the patient and PFNA II. Illustrations were sourced by a manual of PFNA and PFNA II15).

  • Fig. 3 (A) This preoperative anteroposterior radiograph illustrates an unstable intertrochanteric fracture of the femur with subtrochanteric extension in a 45-year-old woman. (B) Postoperative radiograph after using proximal femoral nail antirotation shows loss of reduction at the fracture site (arrow) with lateral cortical impingement.

  • Fig. 4 (A) This preoperative anteroposterior radiograph illustrates an unstable intertrochanteric fracture of the femur in a 68-year-old woman. (B) Postoperative radiograph after using proximal femoral nail antirotation shows lateral wall fracture (arrow) during nail insertion.


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