Results of the Proximal Femoral Nail-Antirotation (PFNA) in Patients with an Unstable Pertrochanteric Fracture

Yerl-Bo Sung; Sung-Il Jo

doi:10.5371/jkhs.2011.23.1.39

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Sung and Jo: Results of the Proximal Femoral Nail-Antirotation (PFNA) in Patients with an Unstable Pertrochanteric Fracture

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(1): 39-46.

Published online: 31 March 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.1.39

Results of the Proximal Femoral Nail-Antirotation (PFNA) in Patients with an Unstable Pertrochanteric Fracture

Yerl-Bo Sung, MD, Sung-Il Jo, MD

Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University, Seoul, Korea.

Address reprint request to Yerl-Bo Sung, MD. Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University, 761-1 Sang-Gye 7-dong, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1032, FAX: +82-2-934-6342, ybs58@paik.ac.kr

Received 29 October 2010 Revised 22 February 2011 Accepted 23 February 2011

Abstract

Purpose

This study was performed to review the results of PFNA (Proximal Femoral Nail Antirotation) for treating unstable femoral intertrochanteric fractures.

Materials and Methods

Forty-seven out of 187 hips treated from September 2006 to March 2010 with PFNA for unstable femoral pertrochanteric fractures were enrolled in this study. The mean duration to radiologic bone union, the functional status and the complications were assessed. The Cleveland index, the tip apex distance, the sliding distance of the blade and the change in the neck-shaft angle were also measured.

Results

The mean duration to radiologic bone union was 15.8 weeks and 66% of the patients recovered to a premorbid functional status. The average amount of blade sliding was 5.5 mm and the mean change of the neck-shaft angle was varus 4.4°. There were 2 cases of penetration of the blade tip, 2 cases of impending penetration, one case of posttraumatic osteonecrosis of the femoral head and 2 cases of lateral wall fractures.

Conclusion

PFNA would be preferable for unstable femoral intertrochanteric fractures in terms of the short operation time, the rapid ambulatory recovery and the reduced complications. Yet careful handling is required to avoid a grave complication such as head penetration.

Keywords: Femur, Unstable pertrochanteric fracture, PFNA (Proximal Femoral Nail Antirotation)

Figures and Tables

Fig. 1

The Cleveland Index.

Fig. 2

(A) Preoperative antero-posterior (AP) radiograph of a 81 year-old woman shows A.O classification 2.3 intertrochanteric fracture. (B) Four months after internal fixation with PFNA, AP radiograph shows solid fracture-union.

Fig. 3

(A) Preoperative antero-posterior (AP) radiograph of a 75 year-old female shows AO classification 2.2 intertrochanteric fracture. (B) Three weeks after internal fixation with PFNA, AP radiograph shows lateral wall fracture. (C) After conservative treatment, radiograph shows union of lateral wall fracture.

Fig. 4

(A) Preoperative antero-posterior (AP) radiograph of a 71 year-old female shows AO classification 2.2 intertrochanteric fracture. (B) Immediate postoperative AP radiograph shows internal fixation with PFNA. (C) AP radiograph 2 months after the operation shows blade penetration into the hip joint. (D) The blade was exchanged into shorter one. (E) Four months after the 2nd operation, AP radiograph shows union.

Table 1

Dermographics (N=47)

^*PFNA; Proximal Femoral Nail Antirotation,

^†Type; AO classification

Table 2

Walking Ability by Koval

Table 3

Postoperative Complication

^*AVN; Avascular necrosis

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