The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table

Jeoung Ho Kim; Sang Hong Lee; Kwang Chul Lee; Sung Won Cho

doi:10.12671/jkfs.2011.24.3.217

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Kim, Lee, Lee, and Cho: The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(3): 217-222.

Published online: 15 July 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.3.217

The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table

Jeoung Ho Kim, M.D., Sang Hong Lee, M.D., Kwang Chul Lee, M.D., Sung Won Cho, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Sang Hong Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, shalee@chosun.ac.kr

Received 16 February 2011 Revised 23 March 2011 Accepted 15 May 2011

(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

The purpose of this study is to analyze the results of intertrochanteric fractures treatment with proximal femoral nail antirotation (PFNA) without using fracture tables and thereby prevent complications.

Materials and Methods

Forty cases of intertrochanteric fracture of 39 patients that were treated with PFNA without using fracture tables between January 2008 to December 2009 were analyzed. There were 13 males and 27 females. The mean age was 76 years old. Using AO classification, 6 cases were A1, 25 cases were A2 and 9 cases were A3. The operation was done without using fracture tables at supine position. Operation time, intraoperative bleeding were checked. For the result, Cleveland index, tip apex distance, fracture site sliding rate, change of femur neck and shaft angle were evaluated. Bone union time and complications were also estimated from the follow up radiograph. Statistics were analyzed using Independent T-test.

Results

The mean operation time was 40 minutes (25 to 70 minutes) and mean intraoperative bleeding was 113 cc (40 to 250 cc). The Cleveland index was shown 94% of 5, 6, 8 and 9 zone, the tip apex distance was 12.96 mm (6 to 22 mm), the fracture sliding distance was 1.9 mm (0 to 6 mm), the change of femur neck and shaft angle was 2.5 degree (0~10 degree) and the average bone union time was 15 weeks (8 to 24 weeks). The complication include 2 cases of delayed union and 2 cases of varus deformities.

Conclusion

We have shortened the operation time by closed reduction methods without using the fracture tables, and the complication were minimized with using simple tools like a reduction forcep or bone hook at PFNA blade insertion.

Keywords: Femur, Intertrochanteric fracture, Proximal femoral nail antirotation (PFNA), Fracture table

Figures and Tables

Fig. 1

(A) C-arm image is checked without using fracture table preoperatively.

(B) Closed reduction is done under C-arm image.

Fig. 2

(A) Preoperative radiograph show unstable intertrochanteric fracture of a 83 year-old female.

(B) Guide wire is inserted after mannual reduction.

(C, D) Fracture site is reduced by using bone hook and guide pin inserted for blade.

(E) Fracture site is reduced on C-arm image satisfactory.

(F) Postoperative radiograph after fixation with a PFNA.

(G, H) Radiograph made 3 months postoperatively showing a bone union.

Table 1

Function assessment

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