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Woo, Lee, Shin, and Suh: Results of Patients with Unstable Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation II
Original Article

Journal of the Korean Orthopaedic Association 2015; 50(4): 290-298.

Published online: 24 August 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.4.290

Results of Patients with Unstable Femoral Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation II

Seung Hun Woo, M.D., Sang Min Lee, M.D., Won Chul Shin, M.D., Kuen Tak Suh, M.D., Ph.D.

Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

Correspondence to: Kuen Tak Suh, M.D., Ph.D. Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. TEL: +82-55-360-2125, FAX: +82-55-360-2155, kuentak@pusan.ac.kr

Received 12 April 2015       Revised 27 May 2015       Accepted 16 June 2015

Copyright © 2015 by The Korean Orthopaedic Association

(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/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: femur, intertrochanteric fracture, proximal femoral nail antirotation II

Figures and Tables

Figure 1

Proximal femoral nail antirotation (PFNA) is proximally rounded contrary to PFNA II, which has a more flattened lateral surface. The medial lateral angle of PFNA II is decreased to 5 degrees (sourced by a manual of PFNA and PFNA II).12)

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Figure 2

The helical blade was placed in the ideal position. Seventysix blades were placed in zone 5, one blade was placed in zone 6, and thirty-one blades were placed in zone 8.

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Figure 3

(A) An 81-year-old female who had an autobicycle traffic accident sustained an unstable left intertrochanteric hip fracture (AO 31A3.3). (B) A proximal femoral nail antirotation II was placed and postoperative X-ray shows acceptable reduction and optimal blade position in the femoral head. (C) The patient fell from bed and nail breakage occurred at postoperative 11 weeks. (D) Nail removal and locking plate fixation was performed. Last follow-up X-ray shows complete fracture healing.

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Figure 4

(A) A-66-year-old female who fell from a bed height sustained an unstable left intertrochanteric hip fracture (AO 31A3.3). (B) A proximal femoral nail antirotation II was placed and postoperative X-ray shows acceptable reduction and optimal blade position in the femoral head. (C) Postoperative 6 weeks, distal locking screw loosening has occurred (arrows). (D) Last follow-up X-ray shows fracture site nonunion.

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Table 1

Demographic Data of Patients

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Values are presented as number only or median (range).

Table 2

Postoperative Reduction Classification*

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Values are presented as number (%). *I) Alignment: (a) Anteroposterior view: Normal cervico-diaphyseal angle or slight valgus; (b) Lateral view: Less than 20 degrees of angulation. II) Displacement of main fragments: More than 80% overlapping in both planes; Less than 5 mm of shortening.

Table 3

Radiologic Results of PFNA II

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Values are presented as number only or median (range).

Table 4

Clinical Results of PFNA II

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Values are presented as median (range). *Charnley hip pain score: best possible score=6 and worst possible score=1.

Table 5

Recovery of Walking Ability and Activities of Daily Living

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Values are presented as number only or number (%).

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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