Fixation in Intertrochanteric Fractures Using Short Proximal Femoral Nail Anti-Rotation-2: A Functional and Radiological Prospective Study.

Abstract

Introduction: Intertrochanteric fractures are among the most common fractures in elderly patients, often associated with osteoporosis and high morbidity. Surgical fixation is the preferred treatment approach to enable early mobilization and reduce complications. The Short Proximal Femoral Nail Anti-Rotation-2 (PFNA-2) has emerged as an effective implant for these fractures, offering improved stability, enhanced biomechanical properties, and reduced risk of implant failure. This study aims to evaluate the functional and radiological outcomes of PFNA-2 in the management of intertrochanteric fractures.

Materials and methods: This prospective study was conducted at the Department of Orthopaedics, Chettinad Health Institute, Tamil Nadu, involving 50 patients with Boyd and Griffin Type 1-4 intertrochanteric fractures. Functional outcomes were assessed using the Modified Harris Hip Score (MHHS), while radiological outcomes were evaluated based on fracture union time, neck-shaft angle, and tip-apex distance (TAD). Patients were followed for a minimum of 6 months postoperatively, with serial radiographic assessments conducted at 6, 12, and 24 weeks. Post-operative rehabilitation included early mobilization, pain management, and weight-bearing exercises to optimize recovery.

Results: The mean age of the study population was 69.04 ± 10.69 years, with a slight female predominance (52%). The mean MHHS was 83.08 ± 8.005, with 44% of patients categorized as having good outcomes and 26% classified as excellent. Younger patients demonstrated significantly better functional outcomes (P = 0.000). The mean neck-shaft angle was 130.6° ± 2.1°, with no significant variation across demographic groups (P = 0.191). The mean TAD was 18.25 ± 4.89 mm, with 12% of patients having a TAD >25 mm. Post-operative complications were minimal, with screw cut-out occurring in 4% of cases and superficial wound healing delays in 2%.

Conclusion: The findings suggest that PFNA-2 provides effective fixation and favorable functional outcomes in intertrochanteric fractures, particularly in elderly patients. With minimal complications and early mobilization benefits, PFNA-2 proves to be a reliable implant for optimizing recovery. Future studies with larger cohorts and longer follow-ups are recommended to validate these findings.