Journal List > J Korean Fract Soc > v.26(2) > 1037923

J Korean Fract Soc. 2013 Apr;26(2):151-155. Korean.
Published online April 22, 2013.  https://doi.org/10.12671/jkfs.2013.26.2.151
Copyright © 2013 The Korean Fracture Society
Excessive Sliding of the Helical Blade and the Femoral Neck Fracture after Insertion of Proximal Femoral Nail Anti-Rotation for Type A2 Intertrochanteric Fractures - A Case Report -
Bong-Ju Park, M.D., Hong-Man Cho, M.D., Ju-Han Kim, M.D. and Woo-Jin Sin, M.D.
Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea.

Address reprint requests to: Hong-Man Cho, M.D. Department of Orthopedic Surgery, Gwangju Veterans Hospital, 91 Sanwol-ro, Gwangsan-gu, Gwangju 506-705, Korea. Tel: 82-62-602-6162, Fax: 82-62-602-6164, Email: chm1228@naver.com
Received December 06, 2012; Revised February 05, 2013; Accepted February 05, 2013.

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

Proximal femoral nail anti-rotation (PFNA) with a lag screw that is shaped like a spiral blade shape is an orthopedic implant to fix trochanteric fractures of the proximal femur. In addition the reason of the biomechanical advantages, PFNA widely been used recently. We report an 83-year-old man with excessive sliding of the helical blade and a femoral neck fracture after AO/OTA type A2 intertrochanteric fracture, which was fixed with a PFNA.

Keywords: Femur; Proximal fracture; Proximal femoral nail anti-rotation (PFNA); Sliding

Figures


Fig. 1
An 83-year-old male with right hip pain.

(A) Preoperative radiology showed AO/OTA type A2.2 intertrochanteric fracture.

(B) Preoperative 3-dimensional computerized tomography showed AO/OTA type A2.2 intertrochanteric fracture.

(C) Immediate postoperative radiology showed fixation with proximal femoral nail anti-rotation.

(D) Radiologic finding on his postoperative 16 weeks showed slight sliding of the helical blade.

Click for larger image


Fig. 2
(A) Anteroposterior radiograph taken 20 weeks after the operation showing back-out of the helical blade and femur neck fracture.

(B) Bipolar hemiarthroplasty was done.

Click for larger image


Fig. 3
(A) The retrieved femoral head showing subcapital femur neck fracture.

(B) Biopsy finding was normal mature trabecular bone and marrow fat tissue (H&E, ×40).

Click for larger image

References
1. Brunner A, Jöckel JA, Babst R. The PFNA proximal femur nail in treatment of unstable proximal femur fractures--3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma 2008;22:731–736.
2. Byun YS, Yoo CH, Nam JM, Cho YH, Shin DJ. Unstable trochanteric fractures of the femur treated with a condylar blade plate. J Korean Soc Fract 2002;15:320–327.
3. Jang SA, Cho YH, Byun YS, Cho HS, Choi S, Yoo HS. A case report of unique complications of PFNA penetration of the blade into the hip joint. J Korean Hip Soc 2011;23:318–322.
4. Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 2009;40:428–432.
5. Niikura T, Lee SY, Matsumoto T, et al. Backout of the helical blade of proximal femoral nail antirotation and accompanying fracture nonunion. Orthopedics 2012;35:e1264–e1266.
6. Park JH, Lee YS, Park JW, Wang JH, Kim JG. A comparative study of screw and helical proximal femoral nails for the treatment of intertrochanteric fractures. Orthopedics 2010;33:81–85.
7. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury 1999;30:327–332.
8. Simmermacher RK, Ljungqvist J, Bail H, et al. AO - PFNA studygroup. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury 2008;39:932–939.
9. Sommers MB, Roth C, Hall H, et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 2004;18:361–368.
10. Takigami I, Ohnishi K, Ito Y, et al. Acetabular perforation after medial migration of the helical blade through the femoral head after treatment of an unstable trochanteric fracture with proximal femoral nail antirotation (PFNA): a case report. J Orthop Trauma 2011;25:e86–e89.