A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis (original) (raw)
Related papers
https://www.ijrrjournal.com/IJRR\_Vol.5\_Issue.9\_Sep2018/Abstract\_IJRR0012.html, 2018
Background: The incidence of unstable intertrochanteric fracture in elderly is rising because of increased age and with low bone mineral density. The presence of osteoporosis in intertrochanteric fractures is important because fixation of the proximal fragment depends entirely on the quality of cancellous bone present. The surgical stabilization of unstable intertrochanteric fractures remains a persistent challenge. The purpose of this study is to study the effectiveness and drawbacks of one such newer intramedullary device, Proximal Femoral Nail Antirotation in management of intertrochanteric fractures. Patients and method: After obtaining clearance from hospital ethical board, patients who underwent PFNA for unstable intertrochanteric fractures at a tertiary care center, Mumbai, who have given written and informed consent. Patients fitting into inclusion criteria would form the study group. Sample size was calculated using Post-hoc analysis sample size calculator. Data collected by interviews, observation of clinical and radiological findings and assessment of function done using Harris hip score. Categorical data was analyzed by using Chi-square test and comparison of results done using Paired t test. Results: The study comprised of 40 patients, with a mean age of mean age 77± 8.93 years who suffered unstable fracture intertrochanteric femur, due to either trivial fall (82.50%) or RTA (17.50%) and managed by cephalomedullary nailing using Proximal Femoral Nai Antirotation at our centre. Majority of the patients had quality of reduction; Majority of patients took 14 weeks for union with mean union time of 14.2 weeks with standard deviation of ± 1.29. Patients were asked to follow up routinely, with post operative follow up ranging from minimum of 20 weeks to 9 months. At final follow up following results obtained according to Harris Hip Score, were-45% patients Excellent, 32.50% patients-Good, 20% patients-Fair, 2.50% patients-Poor. Conclusions: The intertrochanteric fracture in elderly patients treated with cephalomedullary nailing using proximal femoral nail-antirotation, which has biomechanical advantage of helical blade providing bone compaction, increasing surface area and better anchorage in femoral head, which showed favorable outcome by retarding rotation and varus collapse and prevents medialization by acting as a central pillar.
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 ...
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.
Evaluation of the results of the proximal femoral nail surgery for intertrochanteric femur fractures
Medicine Science | International Medical Journal, 2022
This study aimed to evaluate the clinical, functional, and radiological results of the patients who underwent proximal femoral nail (PFN) surgery due to intertrochanteric femur fractures (IFF). A total of 195 patients who underwent PFN surgery due to IFF in January 2014 and January 2018 in our institute and with at least six months follow-up periods were included in the study. Demographic data, comorbidities, Evans-Jensen fracture classification, anesthesia risk scores, hospitalization duration, time to surgery, duration of surgery, amount of blood loss, whether additional traumas exist, quality of reduction, complication rates, Harris hip scores (HHS), Fogagnolo Reduction Quality criteria and possible correlations between these variables were evaluated retrospectively. In our study, the majority of the patients were found to be between the ages of 70-90. Hypertension was found to be the most common comorbid disease in the patients (50.2%). The fracture type of the majority of the patients was determined as type 4. The majority of patients were identified as ASA III and ASA IV group patients (38.4% and 35.9%, respectively). Successful HHS was found at a rate of 77.5%. As the fracture type worsened, the HHS score worsened (p<0.05). Reoperation rates were significantly lower in those with good reduction quality than those with poor reduction (p<0.05). A significant association was found between the overall complication rate and reduction quality (p<0.05). A significant and negative correlation was found between HHS scores and total complication rates (p<0.05). Intertrochanteric femur fractures are frequently encountered by orthopedists. These fractures, which require surgical intervention in almost all of them, are important because the population is old and prone to complications, and accurate and rapid surgical intervention is required. Our results suggest that PFN surgery is an appropriate choice for IFF.
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.
Journal of Chittagong Medical College Teachers' Association
Background: The aim of this study is to evaluate the management of intertrochanteric fracture of the femur using Proximal Femoral Nail Antirotation (PFNA). Materials and methods: Sixty patients of unstable pertrochanteric fractures were treated by closed reduction and internal fixation by proximal femoral nail antirotation from July 2015 to June 2017. Four patients were lost to follow-ups. The remaining 56 patients were followed for a mean period of 2 years. The results were evaluated by assessing the patients regarding their clinical and functional outcome at follow up as per kyle’s criteria Results: Peroperative failure to proximal head neck blade fixation (n-1) jamming of nail (n=2) and post operative lateral migration of head neck blade (n=1) and fracture related infection (n=1) were complications observed. End results were excellent in 46.34%, good in 36.58%, fair is 14.64% and poor in 2.43%. Conclusion: Proximal Femoral Nail Antirotation (PFNA) is the biomechanically and biolo...
Injury, 2015
Proximal femur fractures are frequently observed in the elderly population [1]. The incidence of these fractures increase with age. After the age of 50 years, the incidence rate doubles each decade. The incidence is two to three times higher in women than in men [2,3]. The presence of osteoporosis is an important cofounding parameter in the occurrence of these fractures where almost 90% of these injuires in the geriatric population are sustained by following a simple fall [4]. Hip fractures are grouped under three categories based on the anatomical location of the injury being intracapsular, intertrochanteric, and subthrochanteric femur fractures [5]. Intracapsular Injury, Int. J. Care Injured xxx (2015) xxx-xxx
International Journal of Orthopaedics Sciences, 2019
Background: Intertrochanteric fractures of the femur are fairly common injuries seen in Orthopaedic practice and have a bimodal age distribution. Various modalities of treatment are available in the management of these fractures. The aim of this study was to evaluate the role of the proximal femoral nail (PFN) in the management of these fractures and to assess the functional outcome using the Harris hip score. Methods: 30 patients with Intertrochanteric fractures of the femur who were willing for surgery and follow up were included in our study and were treated with proximal femoral nail and were followed up for a 3 year period. Results: There was a male preponderance seen in our study with the right hip being more commonly affected. The most common mode of injury was slip and fall followed by road traffic accidents. The mean surgical time was 59.03 minutes and the average time to fracture union was 12.4 weeks. The mean Harris hip score was 83.3 and we had excellent results in 5 patients and good results in 12 of them. Conclusion: Proximal femoral nailing is an effective treatment option in the management of intertrochanteric fractures of the femur and is associated with lesser operating times, minimal blood loss and earlier weight bearing as compared to other fixation methods and rehabilitation of the patients is quite rapid as well leading to a good functional outcome.
Orthopedics
The purpose of our study was to compare the proximal femoral nail antirotation (PFNA; Synthes, Paoli, Pennsylvania) with a reconstruction nail (Recon; Zimmer, Warsaw, Indiana) in the treatment of comminuted proximal femoral fractures. Between 2003 and 2010, twenty-three consecutive patients with AO/Orthopaedic Trauma Association 31-A3 fractures combined with proximal 32 fractures who had a minimum 18-month follow-up were evaluated retrospectively. There were 10 patients (age range, 18-74 years) in the Recon nail group and 13 patients (age range, 22-90 years) in the PFNA nail group. Patients treated with Recon nails experienced a longer operation time (P=.006) and more blood loss (P=.012) than patients treated with the PFNA nail. On postoperative radiographs, the change in the neck-shaft angle was 8.8° in the Recon nail group and 4.7° in the PFNA nail group (P=.048). The fracture union time averaged 31.8 weeks in the Recon nail group and 21.5 weeks in the PFNA nail group (P=.148). Mo...
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...