J Korean Orthop Assoc.  2024 Apr;59(2):117-125. 10.4055/jkoa.2024.59.2.117.

Factors Affecting Telescoping of Spiral Blade after Operation for Intertrochanteric Fracture with Proximal Femoral Nail Antirotation II

• Kim ST
• Kim BS
• Shin S
• Park J
• Sun HM

• KMID: 2555522
• DOI: http://doi.org/10.4055/jkoa.2024.59.2.117

Abstract

Purpose
This study examined the factors influencing the telescoping of the spiral blade after surgery with the proximal femoral nail antirotation II (PFNA II) for intertrochanteric fracture patients.
Materials and Methods
Between January 2017 and January 2022, the degree of telescoping of the spiral blade was measured in 178 patients who underwent surgery with PFNA II for intertrochanteric fractures. Several variables were investigated, including the patient's sex, age, neck shaft angle of the nail, number and horizontal length of the posteromedial bone fragment, degree of osteoporosis in the normal hip, AO Foundation/Orthopaedic Trauma Association classification, tip apex distance, position of the spiral blade in the femoral head, and the reduction status of whether the proximal bone fragment had been adequately reduced into the intramedullary canal of the distal femur. These factors were analyzed statistically to determine their impact on the telescoping of the spiral blade.
Results
The transverse size of the bone fragment and the reduction state of the fracture significantly influenced the telescoping of the spiral blade after surgery.
Conclusion
Inadequate reduction of the proximal bone fragment inside the distal intramedullary cavity must be avoided to prevent excessive telescoping of the spiral blade following intertrochanteric fracture surgery. In addition, in cases where the transverse size of the posteromedial bone fragment is substantial, consideration should be given to either fixing the posteromedial fragment or delaying weightbearing during rehabilitation.

Keyword

femur; intertrochanteric fracture; telescoping of spiral blade; fracture reduction