Mid-term Results of Patients with Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation

Suk Kyu Choo; Hyoung Keun Oh; Sung Jong Woo

doi:10.5371/hp.2012.24.2.124

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Choo, Oh, and Woo: Mid-term Results of Patients with Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(2): 124-132.

Published online: 30 June 2012

DOI: https://doi.org/10.5371/hp.2012.24.2.124

Mid-term Results of Patients with Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation

Suk Kyu Choo, MD, Hyoung Keun Oh, MD, Sung Jong Woo, MD

Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea.

Address reprint request to Hyoung Keun Oh, MD. Department of Orthopedic Surgery, Inje University Ilsan PaikHospital, 2240 Daehwa-dong, Ilsanseo-gu, Goyang 411-706, Korea. TEL: +82-31-910-7968, FAX: +82-31-910-7967, osd11@paik.ac.kr

Received 14 November 2011 Revised 24 May 2012 Accepted 25 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Proximal femur, Intertrochanteric fracture, PFNA

Figures and Tables

Fig. 1

Measurement of sliding using radiographs. (A) Immediate postoperative radiograph. a: total lengthat immediate postoperative state, b: distal end lengthat immediate postoperative state. (B) The last Follow up radiograph. c: total length at the last follow up, d: distal end lengthat the lastfollow up, Correction factor: c/a, Corrected follow up sliding: d/Correction factor, Result: Corrected follow up sliding - d.

Fig. 2

(A) An 80-years old female fell from a standing height and sustained an unstable left intertrochanteric hip fracture (AO31A2.2). (B) A PFNA was placed and postoperative radiograph shows good reduction and optimal blade position in femoral head. (C) Last follow-up X-ray shows complete fracture healing despite of significant sliding of helical blade.

Table 1

Demographic Data for Analysis

Table 2

Postoperative Reduction Classification

Table 3

Katz ADL (Activities of Daily Living) Index

Table 4

Radiologic Results

Table 5

Clinical Results

^*Katz ADL index, 1) Personal hygiene and grooming, 2) Dressing and undressing, 3) Feeding oneself, 4) Functional transfers, 5) Voluntarily controlling urinary and fecal discharge elimination, 6) Ambulation

^†Charnley hip score: best possible score=6 and worst possible score=1

^‡Preoperative free walking: 39 patients, use cane: 2 patients, use walker: 1 patient, use wheel chair: 1 patient

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