Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate

Tae-Ho Kim; Jong-Oh Kim; Seung-Yup Lee; Geon-Ung Yun

doi:10.12671/jkfs.2010.23.4.353

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Kim, Kim, Lee, and Yun: Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(4): 353-359.

Published online: 31 October 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.4.353

Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate

Tae-Ho Kim, M.D.^*, Jong-Oh Kim, M.D., Seung-Yup Lee, M.D., Geon-Ung Yun, M.D.

Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman's University School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea.

Address reprint requests to: Jong-Oh Kim, M.D. Department of Orthopedic Surgery, Mok-dong Hospital, Ewha Woman's University School of Medicine, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-5276, Fax: 82-2-2642-0349, ewhamdos@korea.com

Received 21 April 2010 Accepted 11 August 2010

(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 effectiveness of Proximal Femoral Nail Anti-rotation (PFNA) for the treatment of unstable intertrochanteric fracture comparing with Compression Hip Screw (CHS) with Trochanteric Stabilizing Plate (TSP).

Materials and Methods

With clinical study, 43 patients who were treated surgically for unstable intertrochanteric fractures were retrospectively evaluated. One group was treated with CHS and TSP (Group 1, 22 cases) and the other was treated with PFNA (Group 2, 21 cases). By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Lag screw slippage, Neck-shaft angle change and Union time. And By retrospective medical record review, the clinical results were evaluated with the operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, walking ability change and complication.

Results

There was a lower operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, lag screw slippage and neck shaft angle change in the Group 2 than in the Group 1 (p<0.05).

Conclusion

PFNA showed better results than CHS with TSP in operation time, estimated blood loss, amount of drainage and transfusion, lag screw slippage and neck-shaft angle change.

Keywords: Femur, Intertrochanteric fracture, Proximal femoral nail antirotation, Trochanteric stabilizing plate

Figures and Tables

Fig. 1

Photographs of real implant of TSP (Trochanteric Stabilizing Plate).

Fig. 2

Photographs of real implant of PFNA (Proximal Femoral Nail Antirotation).

Fig. 3

Cleveland index.

Fig. 4

(A) 73 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2.

(B) Postoperative radiograph shows that good reduction and well positioned PFNA blade.

(C) Postoperative 6 mons radiograph shows minimal sliding of PFNA blade and well united fracture site.

Fig. 5

(A) 84 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2.

(B) Postoperative radiograph shows that acceptable reduction but superior positioned lag screw.

(C) Postoperative 8 weeks radiograph shows cutting out of the lag screw.

(D) Reoperation was done with cemented bipolar hemiarthroplasty.

Fig. 6

(A) 73 year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2.

(B) Postoperative radiograph shows that poor varus reduction and superior positioned PFNA blade.

(C) Postoperative 4 weeks radiograph shows cutting out of the PFNA blade.

(D) Reoperation was done with cemented bipolar hemiarthroplasty.

Table 1

Demographic characteristics between the group 1 and 2

Table 2

Comparison of radiographic results

^*TAD: Tip apex distance.

Table 3

Immediately postoperative reduction status

Table 4

Comparison of clinical results

^*EBL: Estimated blood loss.

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