A systematic analysis of clinical outcomes with proximal femoral nail anti rotation unstable intertrochanteric femoral fractures

Abstract

INTRODUCTION: newlineIntertrochanteric fractures in elderly, osteoporotic population are frequently noticed, especially in patients aged over 60 years. These fractures are associated with increased mortality and morbidity. Intramedullary nailing, sliding hip screws and plates are common modalities for fixing these fractures. The advantages of intramedullary nailing include a smaller incision, shorter surgical duration, quicker recovery, and a reduced risk of complications. A more recent intramedullary implant called PFNA-2(Proximal Femur Antirotation-2) was created to improve fixation strength in osteoporotic bones, modified to cater to the Asian population. According to biomechanical research, the PFNA-2 helical blade has a stronger cut-out resistance than other widely used screw systems. newlineMATERIALS and METHODS: newlineA total of 30 patients with unstable trochanteric hip fractures were added in the study after considering the inclusion and exclusion criteria. These patients were surgically managed with PFNA-2 intramedullary implant. Evaluation of the clinical and radiological outcome was carried out by various parameters like the surgical duration, intra-operative loss of blood, the length of the hospital-stay, the modified Harris hip score-pain, limp, ambulation, daily activities, range of movements, post-operative complications and the time taken for radiological fracture union. RESULTS: The patients age ranged between 45 to 95 years. The average surgical duration was found to be 69 minutes. The mean intra-operative loss of blood amount of blood loss in surgery was 110 ml. None of the patients had any implant related complications like screw cut-out or pull-out. Functional results according to modified Harris hip scores was found to be excellent in 9/30 patients, good in 14/30 cases, fair in 7/30 cases and poor in no cases, with the average Harris Hip Score at the end of six months being 85.1 newlineCONCLUSION: Elderly patients surgically managed with PFNA-2 has an extremely satisfactory outcome with early weight bearing, less union time and negligible cases of medial penetration and back out of helical blade. newline