No abstract

Introduction: PFNA design compacts the cancellous bone to provide increased stability and has been bio-mechanically proven to retard rotation and varus collapse. We evaluated the early results of treatment of proximal femoral fractures by using PFNA. Methods: Sixty-two patients who underwent PFNA fixation between 2006 and 2007 were reviewed. Fractures were categorised according to the AO/ASIF classification. The quality of fracture reduction, PFNA blade position and neck shaft angle were assessed. The tip-apex distance was measured (TAD). Intra-operative technical difficulties and complications were recorded. Results: Sixty-two patients with a mean age of 78 years (range 44-94 years) were reviewed (20 men and 42 women). Most fractures (48) resulted from low energy injury following a fall. Associated injuries were noted in 15 patients. Majority of the fractures were AO/ASIF types 31A2 (26) and 31A3 (33). Closed reduction was successful in 50 patients and 12 patients required open reduction. Fracture reduction was good in 41, acceptable in 19 and poor in 2 patients. PFNA blade position was central in 52 patients. Mean pre-op neck shaft angle was 132 and post-op was 130. Twenty-four patients had TAD of less than 10 mm, 25 had 10-25 mm and 13 had >20 mm. Technical difficulties were encountered in 14 operations. Fifty-two fractures united between 3 and 4 months. Four patients had delayed union (6-8 months). Two patients were lost to follow-up. Five patients died (2-early post-op period and 3-after 3 months). PFNA blade cutout was noted in two patients. There was no infection. Conclusions: Unstable proximal femoral fractures were treated successfully with the PFNA. The PFNA blade appears to provide additional anchoring in osteoporotic bone.

No abstract

No abstract

Poorly reduced fractures tend to fail early, whereas late failures are due to non-union. Good reduction with minimal dissection, the use of appropriate nail length, and proper positioning of the nail and screws are necessary to avoid failure or revision.