J Korean Fract Soc.  2008 Apr;21(2):103-109. 10.12671/jkfs.2008.21.2.103.

Treatment of Intertrochanteric Fracture: Comparison of Proximal Femoral Nail and Proximal Femoral Nail A

• Park JH
• Park JW
• Wang JH
• Lee JW
• Lee JI
• Kim JG

• KMID: 2183904
• DOI: http://doi.org/10.12671/jkfs.2008.21.2.103

Abstract

PURPOSE: To evaluate the results of fracture fixation between using Proximal Femoral Nail and using Proximal Femoral Nail A and to analyze the effectiveness of proximal femoral nail A.
MATERIALS AND METHODS
We reviewed 32 patients who suffered from intertrochanteric fracture in our hospital, which were 19 cases of PFN and 13 cases of PFNA. Retrospectively we evaluated mean operation time, amount of bleeding, beginning of ambulation, average union period, changes of neck shaft angle and complication on set of telephone interview and OPD. We also evaluated postoperative capability of function and mobility using 'Social function score' and 'Mobility score'.
RESULTS
PFNA showed shorter mean operation time, less bleeding, shorter average union period, earlier ambulation and less change of neck shaft angle than PFN. Although they didn't show statistical difference, postoperative capability of function and mobility showed statistical and mathematical difference on each group.
CONCLUSION
PFNA showed better results of postoperative function and mobility and less complications than PFN. So treatment using PFNA is better method than that of PFN.

Keyword

Intertrochanteric fracture; PFN; PFNA

MeSH Terms

Fracture Fixation
Hemorrhage
Humans
Interviews as Topic
Nails
Neck
Retrospective Studies
Walking

Figure

• 

  Fig. 1 Proximal femoral nail A (PFNA) and its components (helical blade and its assembly device and nail).

• 

  Fig. 2 (A) 72 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A1.1. (B) We performed closed reduction and intramedullary fixation using PFN. (C) Radiograph which was taken 3 weeks later shows distal migaration of hip pin and neck screw. (D) 14 months later post-operatively, radiograph shows more migration of hip pin and neck screw but union was obtained. She complained of pain because of protruded hip pin and neck screw.

• 

  Fig. 3 (A) 89 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.1. (B) Postoperative radiograph shows closed reduction and intramedullary fixation using PFN. (C) Radiograph taken 9 months later shows more migration of hip pin but union was obtained. (D) So we performed removal of hip pin.

Reference

1. Ahn SJ, Park JH. Proximal femoral nail (PFN) for the treatment of the femoral trochanteric fracture. J Korean Fract Soc. 2004; 17:7–12.

2. Al-yassari G, Langstaff RJ, Jones JW, Al-Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury. 2002; 33:395–399.

3. Bess RJ, Jolly SA. Comparison of compression hip screw and gamma nail for treatment of peritrochanteric fractures. J South Orthop Assoc. 1997; 6:173–179.

4. Boriani S, Bettelli G. The Gamma nail. A preliminary note. Chir Organi Mov. 1990; 75:67–70.

5. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991; 73:330–334.

6. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop. 2001; 25:298–301.

7. Halder SC. The gamma nail for peritrochanteric fractures. J Bone Joint Surg Br. 1992; 74:340–344.

8. Herrera A, Domingo LJ, Calvo A, Martinez A, Cuenca J. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop. 2002; 26:365–369.

9. Ito K, Hungerbühler R, Wahl D, Grass R. Improved intramedullary nail interlocking in osteoporotic bone. J Orthop Trauma. 2001; 15:192–196.

10. Jensen JS. Determining factors for the mortality following hip fractures. Injury. 1984; 15:411–414.

11. Kim BS, Lew SG, Ko SH, Cho SD, Yang JH, Park MS. Treatment of femoral intertrochanteric fracture with proximal femoral nail. J Korean Fract Soc. 2004; 17:1–6.

12. Lenich A, Mayr E, Ruter A, Mockl C, Füchtmeier B. First results with the trochanter fixation nail (TFN): a report on 120 cases. Arch Orthop Trauma Surg. 2006; 126:706–712.

13. Lindsey RW, Teal P, Probe RA, Rhoads D, Davenport S, Schauder K. Early experience with the gamma interlocking nail for peritrochanteric fractures of the proximal femur. J Trauma. 1991; 31:1649–1658.

14. Moon YW, Seo HS, Eun SS, Lim SJ, Park YS. Comparison of the Gamma nail and the proximal femoral nail in the treatment of intertrochanteric fracture. J Korean Hip Soc. 2007; 19:97–104.

15. Moon YW, Suh DH, Kang ST, Kwon DJ, Ji YN, Lee KB. The proximal femoral nail for intertrochanteric fracture of the femur. J Korean Soc Fract. 2003; 16:29–36.

16. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993; 75:797–798.

17. Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004; 86:86–94.

18. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999; 30:327–332.

19. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970; 52:457–467.

20. Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury. 2006; 37:984–989.