J Korean Fract Soc.  2013 Oct;26(4):284-291. 10.12671/jkfs.2013.26.4.284.

The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

• Pak CH
• Lee SH
• Ha SH
• Lee GC
• Song KC

• KMID: 2183829
• DOI: http://doi.org/10.12671/jkfs.2013.26.4.284

Abstract

PURPOSE
The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA).
MATERIALS AND METHODS
Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication.
RESULTS
Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion.
CONCLUSION
With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.

Keyword

Femur; Subtrochanteric fracture; Proximal femoral nail anti-rotation

MeSH Terms

Extremities
Femoral Fractures
Femur
Femur Neck
Follow-Up Studies
Hand Strength
Hip Fractures*
Humans
Retrospective Studies
Walking

Figure

• 

  Fig. 1 (A) Preoperative radiograph shows comminution subtrochanteric fracture of a 61-year-old male from a 2 m fall. (B-D) The fracture was reduced satisfactorily using percutaneous reduction forceps to reverse the deforming forces. (E-G) After using limited open incision, bone hook is maintained in place until a lag screw guide pin is placed in the proper position of the femoral head to prevent recurrence of flexion deformity. (H, I) Postoperative hip anteroposterior and lateral view show a well-reduced subtrochanteric fracture treated with a single large lag-screw cephalomedullary device.

• 

  Fig. 2 (A-C) Initial hip Anteroposterior view, hip joint lateral and pelvis computed tomography images show a spiral subtrochanteric fracture of the femur with a large fragment. (D, E) The fracture was reduced satisfactorily using cable grip and proximal femoral nail antirotation after surgery. (F, G) Fracture healing is evident 1 year after surgery. (H, I) Limited open reduction through a small incision with cable grip was done before nail insertion.

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