Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures

Jee-Hoon Kim; Oog-Jin Shon

doi:10.12671/jkfs.2013.26.4.305

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Kim and Shon: Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures

Original Article

Journal of the Korean Fracture Society 2013; 26(4): 305-313.

Published online: 18 October 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.4.305

Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures

Jee-Hoon Kim, M.D., Oog-Jin Shon, M.D.

Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Address reprint requests to: Jee-Hoon Kim, M.D. Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea. Tel: 82-53-620-3640, Fax: 82-53-628-4240, aek8724@naver.com

Received 16 July 2013 Revised 16 August 2013 Accepted 6 September 2013

(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 compare the results between Proximal femoral nail antirotation II (PFNA II) and Zimmer natural nail Asia type (ZNN) for the treatment of stable intertrochanteric fractures.

Materials and Methods

Between September 2011 and September 2012, 40 consecutive patients with stable intertrochanteric femoral fractures were treated with PFNA II or ZNN. We reviewed 20 cases of PFNA II and 20 cases of ZNN prospectively. We evaluated the operation time, amount of bleeding, mean hospital day, and capability of mobility and function using 'mobility score of Parker and Palmer' and 'social score of Jensen'. We also evaluated the reduction state by the Fogagnolo, Cleveland index, change of tip and apex distance (TAD), sliding distance of cervical screw, change of neck shaft angle and bone union time.

Results

There were no significant differences between the groups treated with PFNA and ZNN. Both groups showed good clinical results. PFNA showed less TAD change and ZNN showed a shorter sliding distance of cervical screw, but they were not statistically different. The bone union time was approximately 13 weeks in both groups.

Conclusion

PFNA and ZNN produced good clinical and radiologic results in the treatment of stable intertrochanteric fractures. There were no significant differences between the groups. Both implants provide good stability and union, so we can conclude that they are both suitable for the treatment of stable intertrochanteric fractures.

Keywords: Femur, Intertrochanteric fracture, Proximal femoral nail anti-rotation, Zimmer natural nail

Figures and Tables

Fig. 1

Photographs of PFNA II (Proximal femoral nail antirotation II).

Fig. 2

Photograph of ZNN (Zimmer natural nail).

Fig. 3

For the Cleveland index, the femur head is divided into nine zones in the axial view to classify the position of the cervical screw.

Fig. 4

(A) Immediate postoperative radiographs show anatomical reduction with PFNA II (proximal femoral nail antirotation II; drawing a dotted line and a full line to measure changes in tip and apex distance [TAD]).

(B) Postoperative 12 weeks radiographs show minimal changes in TAD and a well united fracture site with PFNA II.

Fig. 5

(A) Immediate postoperative radiographs show anatomical reduction with ZNN (Zimmer natural nail; a full line to measure the sliding distance of the cervical screw).

(B) Postoperative 13 weeks radiographs show minimal sliding of the cervical screw and a well united fracture site with ZNN.

Table 1

AO/OTA Classification

PFNA: Proximal femoral nail antirotation II, ZNN: Zimmer natural nail.

Table 2

Demographic Characteristics between the PFNA and ZNN

Values are presented as mean (range). PFNA: Proximal femoral nail antirotation II, ZNN: Zimmer natural nail, BMI: Body mass index.

Table 3

Mobility Score of Parker and Palmer26)

Score is the total.

Table 4

Classification of Reduction by Fogagnolo et al.9)

Table 5

The Assessment of Social Function of Jensen15)

Table 6

Comparison of Clinical Results

Values are presented as mean (range) or difference (preoperative/postoperative). PFNA: Proximal femoral nail antirotation II, ZNN: Zimmer natural nail.

Table 7

Comparison of Radiographic Results

Values are presented as mean (range). PFNA: Proximal femoral nail antirotation II, ZNN: Zimmer natural nail.

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