Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur

Abstract

Introduction:Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures.Material and methods:We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6±11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification).Results and discussion:The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p=0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2±7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6±5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p=0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p=0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p=0.0001).Conclusion:PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient.

A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

“…PFNA is an excellent device for osteosynthesis, as it can be easily inserted. Moreover, it provides for stable fixation, which allows early full mobilization of the patient [ 17 ]. Much research is now being conducted in order to understand the role of cytokines in the development of the inflammatory response following the surgical trauma.…”

Intraoperative failures of the PFNa II spiral blade

“…Common complications for using cephalomedullary devices fixation for proximal femur fracture included shortening, malrotation, malunion, non-union and implant failure or malposition [2,4,8]. Review by Paraschou in 2009, in 257 patients suffered from pertrochanteric fracture and treated with intramedullary nailing, 2 malunions, 1 nonunion, 1 cut out screw and 1 migration of the screw medially were reported.…”

“…It also helps to save money as it shortens the length of hospital stay significantly. The advantages of cephalomedullary devices over convention dynamic hip screws including minimally invasive surgical approach using stab wound incisions, easily inserted implant and superior fixation stability [8].…”

Predictors of Mechanical Failure Rate in Reduction of Intertrochanteric Fracture of the Femur Using Proximal Femoral Nail with Helical Blade

“…During the past few decades, the incidence of intertrochanteric femoral fracture raised due to the significantly increased life expectancy [1]. It is estimated that the incidence of intertrochanteric fracture will double in 2040 [2].…”