Role of Proximal Femoral Nail Antirotation in Management of Unstable Intertrochanteric Fracture of Femur (original) (raw)
Related papers
Outcome of intertrochanteric fracture managed with proximal femoral nail antirotation 2
Asian Journal of Medical Sciences
Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases ...
2020
Objective: To analyze the early outcomes of treatment with proximal femoral nail antirotation (PFNA) in patients with unstable intertrochanteric femoral fracture.Study Design: Retrospective cross-section study. Place and Duration of Study: Pakistan Naval Ship (PNS) Shifa Hospital Karachi, from Jan 2015 to Dec 2016. Methodology: Non-probability convenience sampling was used to include unstable intertrochanteric femoral fractures which were treated with proximal femoral nail antirotation. Outcomes were measured in terms of operating time, per-operative blood loss, postoperative weight bearing and complications. Results: A total of 35 patients were analyzed. Mean age was 69.7 years (range 48-91, standard deviation (SD) ± 2.28). There were 18 males (51.4%) and 17 females (48.6%) patients. Majority of fractures were Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) type 3-1-A-2.3 and were seen in 16 patients (45.7%). Average operative ti...
International Journal of Research in Orthopaedics
Background: The purpose of the present study was to evaluate the theoretical advantages of the proximal femoral nail antirotation in cases of intertrochanteric fractures and also whether it actually alters the eventual functional outcome of the patient. Methods: The present study includes a total 30 patients with intertrochanteric femur fractures managed with proximal femoral nail antirotation between December 2014 to November 2016. In all patients similar standard physical rehabilitation therapy were followed. All complications including intra and postoperative were assessed and recorded. The patients were followed up for over 24 months. Functional outcome was assessed using the Harris hip score. Results: All of 30 cases of intertrochanteric fracture got united with good anatomical position and average time of fracture union was 14 weeks. Postoperative complications included 2 degree varus deformity (n=1, 3%), calcification at tip of greater trochanter (n=4, 13%), sensitivity over TFL (n=2, 7%), medial thigh pain (n=3, 10%). 10 patients developed femoral shortness (mean=0.22 cm, range from 0-1 cm). Average harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 22 (73%) patients showing excellent or good outcome. Conclusions: Proximal femoral nail antirotation (PFNA) represents a significant treatment option in management of intertrochanteric fractures with low complication rate.
International journal of health sciences
Background: Intertrochanteric Femur Fractures are usually complicated withassociated co-morbidities like osteoporosis, diabetes, hypertension, renal failure. In suchcircumstances, nonoperative treatment is mainly reserved for poor medical candidates and non-ambulantpatients with minimal discomfort after fracture. Objective: To study the management of intertrochanteric fractures with proximal femoral nail anti-rotation-II. Material and Methods: Present study was conducted on the patients admitted in at BTGH attached to MR medical college, Kalburgi &Shri B M Patil Medical College Hospital and Research Centre, Vijayapura,with diagnosis of intertrochanteric fractures from October 2017 to April 2019. A total of 21 cases were taken in our study. Results: Majority of the cases i.e., 12(60%) were in the age group of 61- 80 years, followed by 3 cases in the age group 41-60 years. The mean age was 69years. Majority of the patients were males 13 (65%) and 7 (35%) were females. We took less num...
Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur
Medical Archives, 2014
Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. Material and methods: We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6±11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). Results and discussion: The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p=0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2±7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6±5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p=0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p=0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p=0.0001). Conclusion: PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient.
The Open Orthopaedics Journal, 2015
Introduction: Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures. Materials and Methods: We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35-90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement. Results: The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain. Conclusion: We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications.
International Journal of Orthopaedics Sciences, 2021
Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 6 0 to 5 0. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome. Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.
International Journal of Orthopaedics Sciences, 2022
Introduction: Intertrochanteric fractures are the most common geriatric fractures associated with osteoporosis requiring surgical intervention. For fixation of these fractures, use an intramedullary nail coupled with a dynamic femoral head/neck stabilisation implant. Many classes of nails incorporating a single compression screw, an extramedullary device, or a compression screw coupled with an antirotation screw like the proximal femoral nail have become famous for treating unstable fractures. In this study, we studied the outcome of PFNA2 fixation devices. Material and Methods: This is a prospective cohort study of unstable IT fragility fracture of femur treated with PFN A2. All successive patients are diagnosed with unstable intertrochanteric Boyd and Griffin type 2, 3 and 4 fractures of the femur. Results: We found that the average RUSH score at the end of 6 months was 23.8, and the functional outcomes were assessed with HHS with excellent functional outcomes in 20 cases, good in 3 and fair in 2. Complications were varus angulation and infection, one each. Conclusion: PFN A2 has a good functional outcome at the end of 1 year.
Journal of clinical and diagnostic research : JCDR, 2017
Management of unstable intertrochanteric fractures poses challenges in terms of obtaining stable fixation and good postoperative outcomes. There is a paucity of clinical data comparing the commonly used Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) implants, especially in relation to osteoporosis. To assess comparative performance of PFN and PFNA in the setting of osteoporosis. Patients presenting with unstable intertrochanteric fractures (AO 31.A2 and 31.A3) were included and treated with either PFN or PFNA. Preoperative radiographs of normal side were used to grade osteoporosis by Singh's index. Grade 3 or less was considered significant. Postoperative radiographs were assessed for tip-apex distance, Cleveland index and quality of reduction. Patients were followed up for a minimum of nine months and any complications noted. Comparison of functional outcomes was done using the Harris Hip Score and Parker-Palmer mobility score at final follow up. Stat...
International Journal of Research in Orthopaedics
Background: Over the past decades the incidence of intertrochanteric fractures has increased and there is a universal agreement about the intramedullary nail being the preferred implant of fixation for these fractures.Methods: In this study we have attempted to assess and compare the results and immediate as well as long term outcome of fractures managed by proximal femoral nail anti rotation and the intertan nail. We included 102 patients in our study, half in the group managed by proximal femoral nail anti rotation group and half in the group managed by intertan nail. Over a period of almost one and half years we evaluated the patients in immediate and late post op period for the union of the fracture, functional outcomes and the short- and long-term complications.Results: The results were evaluated in the terms of intraoperative variables like fluoroscopy time, mean blood loss and reduction achieved and postoperatively in terms of superficial wound infections and Harris hip score...