Outcome of Intertrochanteric Fractures Treated with Proximal Femoral Nail Antirotation (PFNA)

Abstract

Background: The superiority of PFN (Proximal Femoral Nail) in treatment of intertrochanteric fractures of the hip are well documented but there is no well documented evidence regarding the superiority of PFNA (Proximal Femoral Nail Antirotation). The design of PFNA reduces bone loss and subsequently improves fracture fixation & union. Aims & Objectives: i) To evaluate the outcome of intertrochanteric fractures treated with PFNA. ii) To study the complications associated with the procedure and implant. iii) To compare with well-established studies in literature. Study Design: Prospective Observational Study. Setting: Department of Orthopaedics, Rajawadi Municipal Hospital, Mumbai. Materials & Methods: Total 70 cases of Intertrochanteric fracture satisfying inclusion and exclusion criteria were treated with PFNA from August 2017 to August 2018. The minimum follow up period was 1 year and maximum follow up was for 2 years. Patients were assessed for functional capacity and radiological fracture healing at each follow up. Harris Hip score was used to evaluate functional outcome. Statistics: 22 patients were males and 48 were females. The patient’s age ranged from 40 to 94 years with a mean of 75 years. 32 fractures involved the right side and 38 involved the left side. Of the 70 fractures 14 were AO 31A1, 50 were AO 31A2, 6 was AO 31A3. The length of the nail was 170mm in all of the cases. Most commonly used blade was 95mm. The operative time ranged from 30 min to 100 min with an average of 44 min. Average blood loss was 82 ml. Results: Of 70 patients, 66 Patients (94%) showed radiological union by 3months. Average time for union was 3 months. 2 patients had non-union at the end of 1 year of follow up. No patients had infection or cut out of the blade. 8 patients had migration of the blade. 2 patients had varus collapse. No fractures below the tip of the nail were seen during the follow-up period. Outcome was assessed using Harris Hip Score. Conclusions: Based on our observations we hereby conclude that in intertrochanteric fractures treated with PFNA, we found excellent outcomes with high union rates & very few complications. A randomized trial comparing the PFNA with other devices in elderly patients will probably be required for definitive assessment.