Efficacy of Proximal Femoral Nail Antirotation (PFNA) in the Fixation of Intertrochanteric Femoral Fractures: A Prospective Study on 40 Patients
Efektivitas Antirotasi Kuku Femur Proksimal (PFNA) pada Fiksasi Fraktur Femur Intertrokanterik: Sebuah Studi Prospektif pada 40 Pasien
DOI:
https://doi.org/10.21070/ijhsm.v2i2.96Keywords:
PFNA, intertrochanteric femoral fractures, fixation, functional recovery, complication rateAbstract
Background: Intertrochanteric femoral fractures are common in the elderly population and pose significant challenges in orthopedic surgery. The Proximal Femoral Nail Antirotation (PFNA) has emerged as a promising fixation method, offering biomechanical advantages in the management of these fractures. This study evaluates the effectiveness and outcomes of PFNA in patients with intertrochanteric femoral fractures. Aim: To assess the clinical outcomes, healing efficacy, and complication rates associated with the use of PFNA in the fixation of intertrochanteric femoral fractures. Patients and Methods: In this prospective study, 40 patients with intertrochanteric femoral fractures were treated using PFNA. The cohort was monitored for a follow-up period of 12 months post-surgery. Key outcome measures included fracture union time, functional recovery using the Modified Harris Hip Score, and the incidence of postoperative complications. Results: All 40 patients successfully underwent intertrochanteric femoral fracture fixation with PFNA. The average time to fracture union was observed to be within the expected range for this patient population. Functional recovery, as measured by the Modified Harris Hip Score, showed significant improvement over the 12-month follow-up period. The complication rate was minimal, with only a few cases experiencing minor, manageable complications. There was no incidence of implant failure or significant postoperative morbidity. Conclusion: The study demonstrates that PFNA is a reliable and effective method for fixing intertrochanteric femoral fractures, providing satisfactory stabilization, timely bone healing, and low complication rate. It supports its use as a treatment option, but further studies with larger sample sizes and longer follow-up periods are recommended.
Highlights:
- Evaluate PFNA effectiveness in intertrochanteric femoral fracture fixation.
- Prospective study, 40 patients, 12-month follow-up, functional recovery assessed.
- PFNA ensures stable fixation, timely healing, and low complication rates.
Keywords: PFNA, intertrochanteric femoral fractures, fixation, functional recovery, complication rate
References
Zhang Y. Z., Lin Y., Li C., Yue X. J., Li G. Y., Wang B., Wang Y. Q., and Zhu Z. Q., “A Comparative Analysis of Femoral Neck System and Three Cannulated Screws Fixation in the Treatment of Femoral Neck Fractures: A Six-Month Follow-Up,” Orthop. Surg., vol. 14, pp. 686–693, 2022.
P. Dai, H. Zhou, X. Mao, C. Liu, Z. Wang, and Y. Kang, “Proximal Femoral Nail Anti-Rotation vs Dynamic Hip Screws Decrease the Incidence of Surgical Site Infections in Patients With Intertrochanteric Fractures: A Meta-Analysis,” Int. Wound J., vol. 20, no. 8, pp. 3212–3220, 2023.
A. Hanoun, S. F. Henari, and V. Kumar, Fracture Neck of the Femur, in The Hip Joint, Jenny Stanford Publishing, pp. 595–638, 2021.
S. Hu, S. Du, W. Xiong, S. Chen, H. Song, and S. Chang, “Effectiveness of Proximal Femoral Nail Anti-Rotation for High Plane Intertrochanteric Femur Fractures,” Chin. J. Repar. Reconstr. Surg., vol. 35, no. 3, pp. 307–311, 2021.
S. G. Huang, B. Chen, Y. Zhang, F. F. Nie, L. Ju, M. Li, and Y. H. Zhang, “Comparison of the Clinical Effectiveness of PFNA, PFLCP, and DHS in Treatment of Unstable Intertrochanteric Femoral Fracture,” Am. J. Ther., vol. 24, no. 6, pp. e659–e666, 2017.
Z. Z. Jin, S. Y. Xu, Y. Yang, Y. L. Wei, Y. C. Tian, Z. Y. Wang, and L. H. Bai, “Cemented Hemiarthroplasty Versus Proximal Femoral Nail Anti-Rotation in the Management of Intertrochanteric Femoral Fractures in the Elderly: A Case-Control Study,” BMC Musculoskelet. Disord., vol. 22, p. 846, 2021.
H. Li, Q. Wang, G. G. Dai, and H. Peng, “PFNA vs. DHS Helical Blade for Elderly Patients With Osteoporotic Femoral Intertrochanteric Fractures,” Eur. Rev. Med. Pharmacol. Sci., vol. 22, pp. 1–7, 2018.
Y. Li and Y. Liu, “A Study of the Efficacy and Safety Evaluation of Proximal Femoral Nail Anti-Rotation Fixation for Osteoporotic Intertrochanteric Fractures,” J. Clin. Surg., vol. 26, no. 10, pp. 789–791, 2018.
J. L. M. Loh, D. M. E. Huang, J. Lei, W. Yeo, and M. K. Wong, “Early Clinical Outcomes of Short Versus Long Proximal Femoral Nail Anti-Rotation (PFNA) in the Treatment of Intertrochanteric Fractures,” Malays. Orthop. J., vol. 15, no. 2, p. 115, 2021.
K. Li, H. Yang, Z. Jiang, W. Peng, and X. Zhou, “Effect of Proximal Femoral Nail Anti-Rotation on Clinical Outcome, Inflammatory Factors and Myocardial Injury Markers in Patients With Femoral Trochanteric Fracture,” Am. J. Transl. Res., vol. 14, no. 7, p. 4795, 2022.
W. Liu, J. Liu, and G. R. Ji, “Comparison of Clinical Outcomes With Proximal Femoral Nail Anti-Rotation Versus InterTAN Nail for Intertrochanteric Femoral Fractures: A Meta-Analysis,” J. Orthop. Surg. Res., vol. 15, p. 500, 2020.
D. D. Patil, “Comparative Study of Outcome of Management of Inter-Trochanteric Fractures by Using Proximal Femoral Nail (PFN) and Proximal Femoral Nail Anti-Rotation-II (PFNA-II),” Ph.D. dissertation, Rajiv Gandhi Univ. Health Sci., India, 2019.
Y. J. Seong, J. H. Jang, S. B. Jeon, and N. H. Moon, “Characteristics and Surgical Outcomes of Intertrochanteric or Subtrochanteric Fractures Associated With Ipsilateral Femoral Shaft Fractures Treated With Closed Intramedullary Nailing: A Review of 31 Consecutive Cases Over Four Years at a Single Institution,” Hip Pelvis, vol. 31, no. 4, pp. 190–199, 2019.
T. Tsuda, “Epidemiology of Fragility Fractures and Fall Prevention in the Elderly: A Systematic Review of the Literature,” Curr. Orthop. Pract., vol. 28, no. 6, pp. 580–585, 2017.
X. Wu, G. Li, G. He, W. Li, D. Liu, G. Yang, and Y. Zhang, “Effectiveness of Proximal Femoral Nail Anti-Rotation Assisted by Mesh Locator for Intertrochanteric Fracture in the Elderly,” Chin. J. Repar. Reconstr. Surg., vol. 33, no. 6, pp. 666–670, 2019.
R. Xu, J. Ru, F. Ji, J. Liu, Y. Ji, Z. Wu, and D. Shi, “Comparison of Efficacy, Complications and TGF β2 Expression Between DHS and PFNA in Elderly Patients With Osteoporotic Femoral Intertrochanteric Fracture,” Exp. Ther. Med., vol. 16, no. 1, pp. 394–399, 2018.
H. Zhang, X. X. Zhu, G. W. Pei, X. S. Zeng, N. Zhang, P. Xu, D. Chen, W. G. Yu, and X. C. Zhang, “A Retrospective Analysis of the InterTan Nail and Proximal Femoral Nail Anti-Rotation in the Treatment of Intertrochanteric Fractures in Elderly Patients With Osteoporosis: A Minimum Follow-Up of 3 Years,” J. Orthop. Surg. Res., vol. 12, p. 147, 2017.
M. Li, L. Wu, Y. Liu, and C. Wang, “Clinical Evaluation of the Asian Proximal Femur Intramedullary Nail Anti-Rotation System (PFNA-II) for Treatment of Intertrochanteric Fractures,” J. Orthop. Surg. Res., vol. 9, pp. 1–8, 2014.
