J Korean Orthop Assoc.  2011 Oct;46(5):392-398.

Proximal Femoral Nail Antirotation and Proximal Femoral Nail in Intertrochanteric Fractures

• Kim SS
• Kim CH
• Kang JH
• Han DH
• O YS

Abstract

PURPOSE
The purpose of this study was to compare the curative effect of Proximal Femoral Nail Antirotation (PFNA) with a Proximal Femoral Nail (PFN) for the treatment of intertrochanteric fracture of the femur.
MATERIALS AND METHODS
This study compared 58 cases of 57 patients who were treated by PFNA from June 2007 to February 2009 with 60 cases of 58 patients who were treated by PFN from July 2005 to May 2007. The mean duration of follow-up was 17.2 months (range: 12-31 months). All the fractures were classified according to the AO/ASIF systems. The operative time, the average number of days of hospitalization, the amount of bleeding, the incidence of complications, the union time as assessed on radiologic examinations, the tip apex distance (TAD), the outcome according to the Cleveland index, the change of the neck shaft angle and the amount of sliding at the end of follow-up were compared between the two groups. The clinical outcomes were compared according to the mobility score of Parker, Palmer, Jensen. The results were analyzed using the Student T-test and chi-square tests.
RESULTS
There was no significant difference in blood loss during surgery, the number of hospitalization days, radiographic bone union and TAD (p>0.05). Compared with PFN, the operation time, the postoperative sliding and the neck shaft angle change were significantly less in the PFNA group (p<0.05). For the postoperative complications, there was 1 case of cutting out and 1 case of superficial infection in the PFNA group, and there were 4 cases of cutting out, 2 cases of back out, 2 cases of varus collapse, 1 case of nonunion and 1 case of superficial infection in the PFN group.
CONCLUSION
Using the PFNA had relatively satisfying clinical results for the treatment of intertrochanteric fracture, as compared with those of using PFN.

Keyword

intertrochanteric fracture; proximal femoral nail antirotation; proximal femoral nail

MeSH Terms

Follow-Up Studies
Hemorrhage
Hip Fractures
Hospitalization
Humans
Incidence
Nails
Neck
Operative Time
Postoperative Complications

Figure

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  Figure 1 Cleveland index. (A) PFN (Proximal Frmoral Nail), (B) PFNA (Proximal Femoral Nail Antirotation).

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  Figure 2 Radiographs of A2 fracture in a 84-year-old female patient with PFNA. (A) Preoperative radiograph, (B) Immediate postoperative radiograph, (C) Screw cutting-out occurred at 5 months.

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  Figure 3 Radiographs of A2 fracture in a 89-year-old female patient with PFN. (A) Preoperative radiograph. (B) Immediate postoperative radiograph. (C) Screws back-out and cutting-out occurred at 9 weeks. (D) Screw removal and then bipolar hip arthroplasty were done.

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