ABSTRACT
BACKGROUND: Proximal femoral nail is the first choice for treating intertrochanteric fractures. The studies concerning proximal femoral nail for senile intertrochanteric fractures mainly focus on proximal femoral nail antirotation/proximal femoral nail antirotation II, Gamma 3 and intertrochanteric antegrade nail. OBJECTIVE: To investigate the clinical efficacy of proximal femoral nail antirotation II versus intertrochanteric antegrade nail in the treatment of intertrochanteric fracture in the elderly. METHODS: Forty-two cases of senile intertrochanteric fractures at Department of Orthopedics, First People’s Hospital of Xuancheng City from January 2016 to December 2018 were included, involving 15 males and 27 females, aged 65-90 years. Among which, 22 patients received internal fixation using proximal femoral nail antirotation II and 20 patients using intertrochanteric antegrade nail. The operation time, intraoperative blood loss, fracture healing time, postoperative complications and the hip function scores at last follow-up were compared. The study was approved by the Ethics Committee of First People’s Hospital of Xuancheng City, approval No. (2015)(17). RESULTS AND CONCLUSION: (1) The operation time in the proximal femoral nail antirotation group was shorter than that in the intertrochanteric antegrade nail group [(69.4±11.5), (90.0±9.7) minutes, P 0.05]. (3) In the proximal femoral nail antirotation group, three cases suffered from pain at the affected limb, and one case of coxa vara deformity. One case in the intertrochanteric antegrade nail group appeared with pain at the affected limb. The postoperative incidence of complications between two groups showed no significant difference (18.2%, 5.0%, P > 0.05). (4) No significant difference was found in the Harris scores at the last follow-up between two groups (90.3±2.8, 91.5±2.4, P > 0.05). (5) There were no fracture adverse reactions related to internal fixation materials in the two groups. (6) In summary, proximal femoral nail antirotation II and intertrochanteric antegrade nail internal fixation are effective methods for intertrochanteric fractures in the elderly. However, proximal femoral nail antirotation II has short operation time and few intraoperative blood losses.
ABSTRACT
PURPOSE: This study seeks to determine the anatomically optimal entry point of proximal femoral nail antirotation-II (PFNA-II®) according to geographic features of Korean cadaveric femoral trochanters for successful reduction of osteoporotic proximal femoral fractures. MATERIALS AND METHODS: Forty-three adult cadaveric femurs without previous fractures or surgeries were included. Anteroposterior (AP) and lateral images of all femurs and PFNA-II® were taken with an image intensifier. Using the image synthesis process via the image editing program (Adobe Photoshop CS6), the optimal entry point was verified and compared with the tip of the greater trochanter (GT) and the cervicotro-chanteric junction on AP images, as well as the width of the trochanter and the neck on lateral images. RESULTS: The optimal entry point of PFNA-II® was an average distance of 9.1 mm (range, 7–15 mm) medially from the tip of GT on AP images. The center of the nail was located at an average of 30% (range, 21%–44%) area from the posterior margin of the middle neck, which is an average area of 38% (range, 26%–48%) from the posterior cortex of the trochanter on lateral images. Furthermore, the ideal entry point was at the extended line of the cervico-trochanteric junction. CONCLUSION: The optimal entry point, which was found to be medial to the tip of the GT and posterior to the center of the middle femoral neck and the trochanter, was at on the extended line of the cervicotrochanteric junction.
Subject(s)
Adult , Humans , Cadaver , Femoral Fractures , Femur , Femur Neck , NeckABSTRACT
PURPOSE: The purpose of this study was to evaluate radiologic and functional outcomes of patients with unstable femoral intertrochanteric fractures treated with proximal femoral nail antirotation II (PFNA II). MATERIALS AND METHODS: Between August 2009 and December 2013, 108 hips (108 patients) with unstable femoral intertrochanteric fractures were treated with PFNA II and followed for at least 1 year. The mean follow-up period was 15.2 months. The radiographic outcomes, reduction state, sliding distance of the helical blade, bone union, and complications were assessed. The functional outcomes were assessed according to the Charnley hip pain scoring system, walking ability, and the Activities of Daily Living index. RESULTS: The postoperative radiograph showed a good or acceptable reduction in all cases. The mean sliding length of the blade was 4.1 mm. The mean duration of radiologic bone union was 4.8 months. There were 2 postoperative complications including nail breakage and nonunion. The mean Charnley hip pain score was 5.1 points. Preoperative walking ability was restored for 74.1% of patients. Preoperative activities of daily life were restored for 60.2% of patients. CONCLUSION: PFNA II used for treatment of unstable intertrochanteric fracture showed favorable outcomes. However, due to decreasing walking ability and delayed return to the activities of daily living, further studies are needed, focusing on functional recovery and rehabilitation to improve postoperative clinical outcomes.