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Background: To compare the clinical and radiological outcomes of patients with intertrochanteric fractures treated with PFNA-II versus DHS. Material & Methods:50 adult patients with inter-trochanteric fractures, >20 years old, were randomly distributed into the PFNA-II and DHS groups. DHS with side-plate and proximal femoral nail A-II of appropriate size was used. The patients were regularly followed up till 1 year post-operatively. The clinical, radiological and functional evaluations were done at regular intervals. The peri-operative, early and delayed complications were recorded, and the final outcome of either group was evaluated using the Harris Hip Score. Results:In the DHS group, the mean Harris Hip Score was slightly lower than that of the PFNA-II group at six month follow-up. However, at the 1 year follow-up, both the groups achieved similar Harris Hip Scores. Conclusion:PFNA-II provides a significantly shorter operative time with a smaller incision that leads to lesser blood loss and wound-related complications. However, the incidence of procedural errors was significantly higher in PFNA-II when compared with DHS as it is a technically more demanding procedure that leads to more implant failures and consequent re-operations.
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@#Introduction: Both short and long PFNA are employed to treat intertrochanteric fractures. Controversy exists in the choice between the two nails as each implant has specific characteristics and theoretical advantages. This retrospective study seeks to examine the operative complication rates and clinical outcomes of short versus long (Proximal Femoral Nail Antirotation) PFNA in the treatment of intertrochanteric fractures. Materials and methods: Between July 2011 and February 2015, 155 patients underwent PFNA insertion. The decision on whether to use a short or long PFNA nail, locked or unlocked, was determined by the attending operating surgeon. Visual Analogue Pain Score (VAS) Harris Hip Scores (HHS), Short-form 36 Health Questionnaire (SF-36) and Parker Mobility Scores (PMS) were collected at six weeks, six months and one year post-operatively. Results: A total of 137 (88.4%) patients were successfully followed-up. Forty-two (30.7%) patients received a short PFNA. The patients were similar in baseline characteristics of age, gender, and comorbidities. Operative time was significantly longer in the short PFNA group (62 ±17 mins) versus the long PFNA group (56±17). While the patients in both groups achieved improvement in all outcome measures, there was no significant difference between the groups in terms of HHS (61.0 ±16.0 vs 63.0 ±16.8, p=0.443), PMS (2.3±1.5 vs 2.7±2.1, p=0.545) and VAS (1.7±2.9 vs 1.8 ±2.2 p=0.454). There were 3 (7.1%) and 7 (7.4%) complications in the short versus long PFNA group, respectively. Conclusion: Both short and long PFNA had similar clinical outcomes and complication rates in the treatment of intertrochanteric fractures in an Asian population.
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Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Result: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p=0.028). Bipolar hemiarthroplasty group also had longer length of stay (LoS) (50%) than the PFNA group (32.4%), albeit statistically insignificant (p=0.13). There was no significant difference between the 2-year mortality rate and LoS (p=0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2-year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher LoS than the PFNA group. Future prospective, multi-center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.
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Objective To analyze the efficacy and biomechanical properties of locking proximal femoral plate (LPFP) and proximal femoral nail anti-rotation (PFNA) for treating intertrochanteric fracture in elderly patients. Methods One hundred and six elderly patients with intertrochanteric fracture of femur were randomly divided into LPFP group (53 cases) and PFNA group (53 cases). After treatment intervention, the operation time, intraoperative bleeding volume, weight-bearing time, fracture healing time and Harris hip function score of 9 months after operation in two groups were recorded. The complications after operation in two groups were analyzed. Ten elderly fresh femoral specimens were selected to prepare the model of intertrochanteric femoral fracture in the elderly. They were randomly divided into PFNA group and LPFP group with 5 models in each group. After treatment and intervention, axial compression test, destructive load test and torsional stiffness test were conducted by mechanical testing machine, and biomechanical properties were recorded. Results The average operation time, weight-bearing time and fracture healing time in PFNA group were shorter than those in LPFP group (P<0.05), and the average intraoperative bleeding volume in PFNA group was less than that in LPFP group (P<0.05), and the average Harris score was higher than that in LPFP group (P<0.05). The total incidence of postoperative complications in PFNA group and LPFP group was 7.56% and 18.87%, respectively, indicating a significant difference between the two groups (P<0.05). After intervention treatment, the average axial compression, damage load and torsional stiffness in PFNA group were higher than those in LPFP group (P<0.05). ConclusionsPFNA caused minimal trauma for treating intertrochanteric femoral fractures in the elderly. With its good biomechanical properties, PFNA could effectively promote fracture healing and hip function recovery, and significantly reduce the incidence of hip varus, screw loosening and cutting complications.
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Objective To investigate the clinical effect of proximal femoral nail anti rotation intramedullary nail (PFNA)in the treatment of intertrochanteric osteoporotic fractures in elderly patients.Methods 42 cases of femoral intertrochanteric fracture were treated with proximal femoral nail anti rotation intramedullary nail (PFNA)in cases (AO type,A1 type 13 cases,A2 type 24 cases,type A3 5 cases).Results The group of 42 patients after 12 -36 months of follow -up,the average follow -up time of 18 months,all the patients were healed,1 case of deep venous thrombosis,1 case of mild coxa vara.According to the Harris evaluation standard:excellent 32 cases,good in 9 cases,fair in 1 case,the excellent rate was 97.6%.Conclusion The proximal femoral nail anti rotation (PFNA) anti tensile,anti sliding and anti rotation function is good,and has the advantages of simple operation,small trauma,for osteoporotic intertrochanteric fracture patients can be applied.
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Objective:To compare the effectiveness of proximal femoral nail antirotation (PFNA) with intertrochanteric antegrade nail (InterTAN) in the treatment of intertrochanteric fractures in the elderly. Methods:A retrospective study of 62 elderly patients with intertrochanteric fractures who received two operation methods from Sep 2014 to May 2016 was done. There were 28 patients in PFNA group, and 34 patients in InterTAN group. The operation time, blood loss in operation, hospitalization time, healing time, and Harris hip joint functional score were compared and analyzed. Results:Operation time and the amount of intraoperative blood loss in PFNA group were less than that in InterTAN group. Hospitalization time,fracture healing time and Harris hip joint functional score after ten months had no significant difference between the two groups. And 59 cases in total were followed up with an average of 11.5 months (from 9 to 16 months) . In PFNA group, 27 patients were followed up, and one patient was lost to follow up, who died because of chronic renal insufficiency. The rest 26 patients all achieved bony union (including one case of hip versus) . At follow-up 9 months, hip joint function was excellent in 18 cases, good in 6, fair in 2, bad in 1, and the excellent-good rate was 88.9%. In InterTAN group,32 patients were followed up,and two cases were lost to follow up. In followed-up cases, there was one patient who was no healing of fracture. After hip arthroplasty, this patient got recovery. The hip joint function was excellent in 21 cases, good in 7, fair in 3, and bad in 1. The differences between the two groups were not statisticaly significant. Conclusion:Both PFNA and InterTAN can treat intertrochanteric fractures in the elderly with good result,but PFNA has obvious advantages over InterTAN on less hemorrhage and operation time.
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Objective To compare the clinical curative effect of proximal femoral nail anti rotation ( PFNA) and dynamic hip screw fixation in the treatment of the femoral intertrochanteric fracture,and provide reference for the development of clinical surgery scheme.Methods 74 patients with femoral intertrochanteric fracture in our hospital were selected and randomly divided into observation group and control group,37 cases in each group.The control group was treated with dynamic hip screw fixation,and the observation group was treated with PFNA therapy.Opera-tive time,bleeding volume and wound healing were compared between the two groups.The time of bone healing and complications were compared between the two groups after operation 1,3,6 months, functional recovery of hip was evaluated after operation by Harris score in the two groups.Results Intraoperative bleeding in the observation group was (115.68 ±72.38)mL,the operation time was (43.26 ±11.47)min,which were significantly less than the con-trol group(t=9.62,7.11,all P0.05).1 month after surgery,the Harris score of the observation group was (71.39 ±4.38)points, which was significantly higher than the control group (t=3.17,P0.05 ) .Conclusion PFNA had less surgical trauma,early functional exercise for patients after surgery by comparison with dynamic screw fixation.It could promote fracture and hip joint function rehabilitation.
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PURPOSE: The primary purpose of this study was to demonstrate that the TRIGEN™ INTERTAN nail (InterTAN) could show better clinical outcome compared to the proximal femoral nail antirotation 2 (PFNA2) for treatment of intertrochanteric fracture in the elderly. MATERIALS AND METHODS: Between March 2009 and December 2013, 164 patients with intertrochanteric fractures who met our inclusion and exclusion criteria were enrolled in this study. Evaluation variables, including operation time, blood loss during the operation, incidence of perioperative complications, clinical results at the last follow-up, and radiographic findings were assessed for comparison of the 2 implants. RESULTS: Intraoperative lateral wall fracture was significantly higher in the PFNA2 group (p<0.05) and tip apex distance was significantly higher in the InterTAN group (p<0.05). Sliding of the proximal fragment at the last follow-up was significantly higher in the PFNA2 group. However, there was no significant difference in union rate, time to union, postoperative complications, and clinical outcomes at the last follow-up between the 2 groups. CONCLUSION: Based on these data, clinical outcomes at the last follow-up were equivalent between InterTAN and PFNA2.
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Aged , Humans , Follow-Up Studies , Hip Fractures , Incidence , Postoperative ComplicationsABSTRACT
Objective: To compare and observe the clinical efficacy of ALP and PFNA in treatment of intertrochanteric fractures, to provide clinical evidence for such patients. Methods:The clinical data of 122 cases patients with intertrochanteric fractures admitted to our department from January, 2012 to January, 2013 was analyzed retrospectively. 72 patients treated with PFNA were regarded as the study group and 50 patients with ALP as controls group. Two groups were compared with surgical incision, blood loss, operative time, healing time, hip functional recovery and postoperative complications. Results: The incision length, blood loss, operative time, postoperative weight-bearing activity time, fracture healing time, Harris score and complications of study group were significantly better than the control group (P<0.05), with statistical significance. Conclusion: The long-term efficacy of PFNA and ALP has no difference, but PFNA has smaller wound, less bleeding, sooner fracture healing time and weight-bearing activities and better early results.
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Objective To explore the initial effects of the treatment of proximal femoral nail-helical blade (PFNA) in elderly patients with intertrochanteric fracture of the incomplete lateral wall type. Methods A total of 25 patients were enrolled in this study including 8 cases of type A2, 17 cases of type A3 according to AO classification. All patients under-went three-dimensional CT scan. In all patients with type A2 fracture, there were 6 cases with coronal plane fracture on the greater trochanter, and PFNA was used instead of DHS when an iatrogenic fracture occurred in 2 patients. All other patients were treated with closed reduction and fixed with PFNA. Results All patients healed and the average healing time was 11 weeks, one patient fell down once again and the fracture occurred on the shaft, when a long PFNA was used, both of the frac-tures healed 14 weeks after surgery. In all of the 25 patients,1 patient died due to cerebral hemorrhage 13 months after sur-gery;2 patients needed walking aids due to the presence of osteoarthritis of the knee and calf muscular venous thrombosis was diagnosed in 3 cases. No complications were found in the other patients, such as infection, nonunion and fixation failure. According to the Harris hip score system, there were 14 cases of“excellent”,8 cases of“good”,2 cases of“fair”and1 pa-tient of“poor”.Conclusion The PFNA treatment can provide a good fixation for intertrochanteric fractures of incomplete lateral wall type, which allow patients to do exercise early and achieve an excellent initial outcome.
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Proximal femoral nail anti-rotation (PFNA) with a lag screw that is shaped like a spiral blade shape is an orthopedic implant to fix trochanteric fractures of the proximal femur. In addition the reason of the biomechanical advantages, PFNA widely been used recently. We report an 83-year-old man with excessive sliding of the helical blade and a femoral neck fracture after AO/OTA type A2 intertrochanteric fracture, which was fixed with a PFNA.
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Femoral Neck Fractures , Femur , Femur Neck , Hip Fractures , Nails , OrthopedicsABSTRACT
PURPOSE: To evaluate the mid-term results of patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) in the elderly. MATERIALS AND METHODS: Between March 2008 and February 2010, 93 patients with intertrochanteric femoral fractures were treated with PFNA. Of these patients, 43 could be followed for a mean of 19.1 months (range, 12-33 months). The mean age was 77.3 years (range, 62-93 years) and there were 6 males and 37 females. According to the AO/OTA classification, there were 14 cases of A1, 25 cases of A2, and 4 cases of A3. Radiological outcomes were assessed at the union period along with the sliding distance of the antihelical blade according to fracture type. Functional outcomes were assessed according to the Chanley hip pain scoring system, walking ability, and the Activities of Daily Living (ADL) index. RESULTS: All patients, except for one with a deep infection, had complete union at 3.5 months (range, 2-6 months). Postoperative X-rays showed a good or acceptable reduction in 43 cases(100%), and an ideal blade position without significant differences according to the fracture type. The mean sliding length of the blade was 6.1 mm (range, 0-21 mm) and mean Chanley hip pain score was 4.0 points (range, 0-6.0 points). 19 patients (44%) were restored to their preoperative walking ability. 22 patients(51.2%) were able to live independently without support. CONCLUSION: The PFNA is a very effective implant in the treatment of different patterns of intertrochanteric femoral fractures. But further studies are needed focusing on a functional recovery and rehabilitation to improve postoperative clinical outcomes.
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Female , Humans , Male , Activities of Daily Living , Femoral Fractures , Hip , Hip Fractures , Nails , WalkingABSTRACT
PURPOSE: This study was performed to evaluate the results of treating intertrochanteric fracture with proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS: We performed PFNA on 41 intertrochanteric femur fracture patients from May 2008, to August 2010. We analyzed the operation time, blood loss, recovery of ambulatory function, T-score, the tip apex distance (TAD), the sliding distance of the blade, neck-shaft angle, and complications. RESULTS: The mean operation time was 51 minutes and the mean amount of blood loss was 350 ml. The time to ambulation averaged 7.2 days. Thirty-two cases (79%) recovered their previous walking status at 6 months after operation. The average T-score was 3.3 and TAD was 12.3 mm (8.6~27 mm). 35 cases (87%) achieved acceptable reduction. The average amount of PFNA blade sliding was 3.3 mm. The neck-shaft angle was changed 2.6 degrees varus displacement at the final follow-up. There was one case of nonunion due to tuberculosis infection. CONCLUSION: The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of intertrochanteric fracture of the femur.
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Humans , Displacement, Psychological , Femoral Fractures , Femur , Follow-Up Studies , Hip Fractures , Nails , Tuberculosis , WalkingABSTRACT
Objective To test the mechanical properties such as stiffness and strength of a new proximal femoral nail antirotation (PFNA) with three-dimensional finite element method and analyze its stress and strain distributions before and after the femur intertrochanteric fracture healing. Methods The three-dimensional model of PFNA was established by UG NX and the CT images were preprocessed by MIMICS. The finite element model of intertrochanteric fracture and fracture healing were developed for numerical simulation. Results Before the fracture healing, the maximal Von Mises stress was up to 663 Mpa at the location of fracture and that near the locking bolt was only 113 MPa after PFNA implanted. After the fracture healing, the maximal Von Mises stress occurred at the blade-nail interface. Obvious stress concentrations appeared near the locking bolt on the femur shaft. Conclusions The PFNA should be taken out because the femur shaft fracture often occurred at the location of the locking bolt after healing.
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PURPOSE: This study was performed to review the results of PFNA (Proximal Femoral Nail Antirotation) for treating unstable femoral intertrochanteric fractures. MATERIALS AND METHODS: Forty-seven out of 187 hips treated from September 2006 to March 2010 with PFNA for unstable femoral pertrochanteric fractures were enrolled in this study. The mean duration to radiologic bone union, the functional status and the complications were assessed. The Cleveland index, the tip apex distance, the sliding distance of the blade and the change in the neck-shaft angle were also measured. RESULTS: The mean duration to radiologic bone union was 15.8 weeks and 66% of the patients recovered to a premorbid functional status. The average amount of blade sliding was 5.5 mm and the mean change of the neck-shaft angle was varus 4.4degrees. There were 2 cases of penetration of the blade tip, 2 cases of impending penetration, one case of posttraumatic osteonecrosis of the femoral head and 2 cases of lateral wall fractures. CONCLUSION: PFNA would be preferable for unstable femoral intertrochanteric fractures in terms of the short operation time, the rapid ambulatory recovery and the reduced complications. Yet careful handling is required to avoid a grave complication such as head penetration.
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Humans , Femur , Handling, Psychological , Head , Hip , Hip Fractures , Nails , OsteonecrosisABSTRACT
The proximal femoral nail anti-rotation (PFNA) is a useful device to fix trochanteric fractures of the proximal femur. We report a case of postoperative penetration of the helical blade through the femoral head into the hip joint without any sign of rotational or varus instability in the fracture.
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Femur , Head , Hip , Hip Fractures , Hip Joint , NailsABSTRACT
PURPOSE: The purpose of this study is to analyze the results of intertrochanteric fractures treatment with proximal femoral nail antirotation (PFNA) without using fracture tables and thereby prevent complications. MATERIALS AND METHODS: Forty cases of intertrochanteric fracture of 39 patients that were treated with PFNA without using fracture tables between January 2008 to December 2009 were analyzed. There were 13 males and 27 females. The mean age was 76 years old. Using AO classification, 6 cases were A1, 25 cases were A2 and 9 cases were A3. The operation was done without using fracture tables at supine position. Operation time, intraoperative bleeding were checked. For the result, Cleveland index, tip apex distance, fracture site sliding rate, change of femur neck and shaft angle were evaluated. Bone union time and complications were also estimated from the follow up radiograph. Statistics were analyzed using Independent T-test. RESULTS: The mean operation time was 40 minutes (25 to 70 minutes) and mean intraoperative bleeding was 113 cc (40 to 250 cc). The Cleveland index was shown 94% of 5, 6, 8 and 9 zone, the tip apex distance was 12.96 mm (6 to 22 mm), the fracture sliding distance was 1.9 mm (0 to 6 mm), the change of femur neck and shaft angle was 2.5 degree (0~10 degree) and the average bone union time was 15 weeks (8 to 24 weeks). The complication include 2 cases of delayed union and 2 cases of varus deformities. CONCLUSION: We have shortened the operation time by closed reduction methods without using the fracture tables, and the complication were minimized with using simple tools like a reduction forcep or bone hook at PFNA blade insertion.
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Female , Humans , Male , Femur , Femur Neck , Follow-Up Studies , Hemorrhage , Hip Fractures , Nails , Supine Position , Surgical InstrumentsABSTRACT
PURPOSE: This study compared sliding between (a) lag screws of PFN (Proximal Femoral Nail, AO synthes) and (b) the helical blade of PFNA (Proximal Femoral Nail Antirotation, AO synthes) for femoral intertrochanteric fractures. MATERIALS AND METHODS: We include in our study thirty seven cases who were classified as AO/OTA type A1 femoral intertrochanteric fractures and who underwent hip operations between October 2006 and December 2008. There were 19 patients in the PFN group and 18 in the PFNA group. Degrees of sliding were also measured with postoperative radiology on last follow up compared with immediate postoperative radiology. Both groups were also compared with regard too walking ability using the method of Koval. RESULTS: Average sliding was 5.0+/-2.3 mm for lag screws of the PFN group and 2.8+/-1.3 mm for the helical blade of the PFNA group. The difference was statistically significant (p=0.04). Ambulatory abilities were not statistically different (p=0.33). CONCLUSION: Patients in the PFNA group have less sliding of the implant, but their walking abilities are similar to patients in the PFN group.
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Humans , Femur , Follow-Up Studies , Hip , Hip Fractures , Nails , WalkingABSTRACT
PURPOSE: The purpose of this study was to evaluate the results of treating senile osteoporotic peritrochanteric fracture with proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS: Between November 2006 and December 2007, 21 patients older than 65 years of age with intertrochanteric and subtrochanteric fractures were treated with PFNA. The mean duration of follow-up was 12.9 months and the mean age was 74.5 years. RESULTS: The mean operation time was 48.8 minutes (range: 25-90 minutes). The time to ambulation averaged 7.9 days. Eighty point nine percent (17 cases) of the patients returned to their previous walking status at 6 months after operation. The average T-score was -3.3. Eighteen cases (85.7%) achieved acceptable reduction and the mean time to radiologic bony union was 17.4 weeks. The average amount of PFNA blade sliding was 4 mm and the neck-shaft angle was changed to 1.3 degrees varus displacement at the final follow-up. The complications included pulmonary edema in 1 case and protrusion of the PFNA blade into the hip joint in 1 case. CONCLUSION: Because of the reduced operation time, favorable walking ability and low rate of complications, PFNA is an acceptable alternative for fixation of senile osteoporotic peritrochanteric fracture.
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Humans , Displacement, Psychological , Femur , Follow-Up Studies , Hip Fractures , Hip Joint , Nails , Osteoporosis , Pulmonary Edema , WalkingABSTRACT
PURPOSE: This study was performed to evaluate the usefulness of proximal femoral nail antirotation (PFNA) for internal fixation of femur trochanteric fractures. MATERIALS AND METHODS: We operated on 36 femur trochanteric fracture patients with performing PFNA from September, 2006 to November, 2008 and we analyzed the operation time, the blood loss, the union time, the tip apex distance (TAD), the Cleveland index, the sliding distance of the blade and the complications. We also evaluated the clinical results according to the recovery of ambulatory function and the functional recovery score. RESULTS: The mean operation time was 54 minutes and the mean amount of blood loss amount was 119cc. Thirty two cases progressed to union within 4 months and 4 cases also progressed to union within 6 months without a further operation. The mean TAD was 16mm and the mean sliding distance was 3.8 mm. Clinically, the mean loss of ambulation ability was 1.2 grades and the Jensen functional recovery score was 1.8. There was one case of back out of the blade, but there was no skin problem. There were no significant complications. CONCLUSION: The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of trochanteric fracture of the femur.