Treatment of the Proximal Femoral Fractures with Proximal Femoral Nail Antirotation (PFNA)

Myung-Sik Park; Young-Jin Lim; Young-Sin Kim; Kyu-Hyung Kim; Hong-Man Cho

doi:10.12671/jkfs.2009.22.2.91

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Park, Lim, Kim, Kim, and Cho: Treatment of the Proximal Femoral Fractures with Proximal Femoral Nail Antirotation (PFNA)

Original Article

Journal of the Korean Fracture Society 2009; 22(2): 91-97.

Published online: 30 April 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.2.91

Treatment of the Proximal Femoral Fractures with Proximal Femoral Nail Antirotation (PFNA)

Myung-Sik Park, M.D., Young-Jin Lim, M.D., Young-Sin Kim, M.D., Kyu-Hyung Kim, M.D., Hong-Man Cho, M.D.^*

Department of Orthopaedic Surgery, Medical School, Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea.

^*Department of Orthopaedic Surgery, Daejeon Veterans Hospital, Daejeon, Korea.

Address reprint requests to: Young-Jin Lim, M.D. Department of Orthopaedic Surgery, Chonbuk National University Hospital, 634-18, Guemam-dong, Deokjin-gu, Jeonju 561-712, Korea. Tel: 82-63-250-1760, Fax: 82-63-271-6538, lyj2834@naver.com

Received 28 November 2008 Accepted 7 March 2009

(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 analyze the clinical and radiologic results of treatments in proximal femoral fracture with Proximal Femoral Nail-Antirotation (PFNA).

Materials and Methods

We retrospectively reviewed the results of 21 cases of proximal femoral fracture treated with PFNA from September 2006 to October 2007 which could be followed up for minimum of more than a year. The mean age was 61.5 (20~88) years old. Male were involved in 12 cases, female in 9 cases. The mean follow up was 14.3 (12~18) months. The Garden alignment index, Cleveland index, tip apex distance were evaluated by post-operative radiologic evaluation and complications of bone union, failure of internal fixation and deformity were evaluated by follow up radiologic findings. Clinical results were assessed by social function score of Jensen and mobility score of Parker and Palmer at last follow up.

Results

All fractures were united and the mean time to bone union was 15.7 (13~18) weeks. Garden alignment index showed good results of above 'good' in 15 cases (71.4%), Cleveland index showed 14 cases (66.4%) positioning in zone 5 and tip apex distance showed 17.81 (±5.65~27.52) mm in radiologic findings. The mean sliding of blade was 1.32 (0.34~2.94) mm in follow up radiologic findings and fracture of distal locking screw area was found in 1 case as a complication. Among 21 cases, the function before injury was completely recovered in 15 cases (71.4%) which were assessed by social function score of Jensen and 13 cases (61.9%) by mobility score of Parker and Palmer.

Conclusion

We think that PFNA is effective osteosynthetic device for proximal femur fracture with satisfactory radiologic and clinical outcomes.

Keywords: Femur, Proximal femoral fracture, Proximal Femoral Nail-Antirotation (PFNA)

Figures and Tables

Fig. 1

For the Cleveland Index. The femoral head (axial view) was divided into nine zone to document the position of the tip of the blade.

Fig. 2

The tip apex distance (TAD) is measured between the tip of the helical blade and the cortex of the femural head in the line of the head and neck fragment. The distance has to be measured in the anteroposterior and the axial view.

Fig. 3

(A) Preoperative anteroposterior radiograph of the left hip of a 22 years old man, showing an combined femur shaft and neck fracture.

(B) Postoperative radiograph after fixation with a PFNA.

(C) Radiograph made 6 months postoperatively showing a healed fracture.

(D) Radiograph made 18 months postoperatively after hardware removal.

Fig. 4

(A) Preoperative anteroposterior radiograph of the left hip of a 72 years old man who slip down, showing an intertrochanter fracture AO type A3-3.

(B) Postoperative radiograph after fixation with a PFNA.

(C) Radiograph made 3 months postoperatively showing a periprosthetic fracture at the distal locking screw.

(D) Radiograph made postoperatively after conversion to intramedullary nail.

Table 1

Patient data profile

^*Inter: Intertrochanter femur fracture, ^†A: AO/ASIF classification, ^‡Sub: Subtrochanter femur fracture, ^§S: Seinshiemer classification, ^∥TAD: Tip apex distance.

Table 2

Garden alignment Index

Table 3

The Assessment of Social Function of Jensen

Table 4

The Assessment of Mobility Score of Parker and Palmer

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