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Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures.

Li M, Wu L, Liu Y, Wang C - J Orthop Surg Res (2014)

Bottom Line: Fourteen patients had thigh pain (9.82%), and five had inner thigh pain (3.07%); seven had more severe pain that was improved by physical therapy.PFNA-II has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures.However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Fifth Hospital of Wuhan City (Second Affiliated Hospital of Jianghan University), Wuhan, 430050, Hubei Province, China. lmh061127@163.com.

ABSTRACT

Background: The preferred treatment of intertrochanteric fractures in aged patients is controversial. The purpose of the present study was to evaluate the outcomes of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for stabilization of such fractures.

Methods: The PFNA-II was used to treat intertrochanteric fractures in 163 elderly patients from March 2010 to March 2013. The patients comprised 69 men and 94 women with a mean age of 74.7 ± 13.0 years. All fractures were classified by the Orthopaedic Trauma Association classification system; 53, 83, and 27 fractures were classified as 31A1, 31A2, and 31A3, respectively. We statistically evaluated the intraoperative blood loss, operation time, incision length, X-ray exposure time, and postoperative outcomes. Patients were followed up for a mean of 15.2 months (range, 10-24 months). Functional outcomes were assessed according to the Harris hip scoring system.

Results: Statistical analysis revealed an average operation time of 45.7 min (range, 35-110 min), average intraoperative blood loss of 115.2 mL (range, 65-430 mL), X-ray exposure time of 2.7 ± 1.4 s (range, 2-6 s), and total incision length of 6.5 ± 2.2 cm (range, 5.5-13.0 cm). Patients were followed up for a mean of 14.5 months (range, 10-24 months). The neck shaft angle was 134° ± 15° (range, 115°-150°), and the fracture healing time was 14.0 ± 2.5 weeks (range, 11-19 weeks). The Harris hip score was 85.6 ± 17.5 points (range, 65-100 points) and included 41 excellent cases (25.15%), 92 good cases (56.44%), 26 moderate cases (15.95%), and 4 poor cases (2.45%) for a positive outcome rate of 81.60%. There were no varus hip deformities, screw cutouts, or femoral shaft fractures. Fourteen patients had thigh pain (9.82%), and five had inner thigh pain (3.07%); seven had more severe pain that was improved by physical therapy.

Conclusion: PFNA-II has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures. However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.

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In patients with a short stature, even after the use of a 170-mm PFNA nail, some portion of the long tail was still exposed outside of the greater trochanter, with hip joint activity easily leading to pain. (a, b) Postoperative three-dimensional imaging.
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Fig2: In patients with a short stature, even after the use of a 170-mm PFNA nail, some portion of the long tail was still exposed outside of the greater trochanter, with hip joint activity easily leading to pain. (a, b) Postoperative three-dimensional imaging.

Mentions: In addition, compared with short-statured patients, the distance between the proximal aspect of the nail and the spiral blade still appeared to be relatively long. When the patient moved, the end of the nail exposed outside of the rotor readily came into contact with the iliotibial band, causing pain (Figure 2).Figure 2


Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures.

Li M, Wu L, Liu Y, Wang C - J Orthop Surg Res (2014)

In patients with a short stature, even after the use of a 170-mm PFNA nail, some portion of the long tail was still exposed outside of the greater trochanter, with hip joint activity easily leading to pain. (a, b) Postoperative three-dimensional imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233078&req=5

Fig2: In patients with a short stature, even after the use of a 170-mm PFNA nail, some portion of the long tail was still exposed outside of the greater trochanter, with hip joint activity easily leading to pain. (a, b) Postoperative three-dimensional imaging.
Mentions: In addition, compared with short-statured patients, the distance between the proximal aspect of the nail and the spiral blade still appeared to be relatively long. When the patient moved, the end of the nail exposed outside of the rotor readily came into contact with the iliotibial band, causing pain (Figure 2).Figure 2

Bottom Line: Fourteen patients had thigh pain (9.82%), and five had inner thigh pain (3.07%); seven had more severe pain that was improved by physical therapy.PFNA-II has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures.However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Fifth Hospital of Wuhan City (Second Affiliated Hospital of Jianghan University), Wuhan, 430050, Hubei Province, China. lmh061127@163.com.

ABSTRACT

Background: The preferred treatment of intertrochanteric fractures in aged patients is controversial. The purpose of the present study was to evaluate the outcomes of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for stabilization of such fractures.

Methods: The PFNA-II was used to treat intertrochanteric fractures in 163 elderly patients from March 2010 to March 2013. The patients comprised 69 men and 94 women with a mean age of 74.7 ± 13.0 years. All fractures were classified by the Orthopaedic Trauma Association classification system; 53, 83, and 27 fractures were classified as 31A1, 31A2, and 31A3, respectively. We statistically evaluated the intraoperative blood loss, operation time, incision length, X-ray exposure time, and postoperative outcomes. Patients were followed up for a mean of 15.2 months (range, 10-24 months). Functional outcomes were assessed according to the Harris hip scoring system.

Results: Statistical analysis revealed an average operation time of 45.7 min (range, 35-110 min), average intraoperative blood loss of 115.2 mL (range, 65-430 mL), X-ray exposure time of 2.7 ± 1.4 s (range, 2-6 s), and total incision length of 6.5 ± 2.2 cm (range, 5.5-13.0 cm). Patients were followed up for a mean of 14.5 months (range, 10-24 months). The neck shaft angle was 134° ± 15° (range, 115°-150°), and the fracture healing time was 14.0 ± 2.5 weeks (range, 11-19 weeks). The Harris hip score was 85.6 ± 17.5 points (range, 65-100 points) and included 41 excellent cases (25.15%), 92 good cases (56.44%), 26 moderate cases (15.95%), and 4 poor cases (2.45%) for a positive outcome rate of 81.60%. There were no varus hip deformities, screw cutouts, or femoral shaft fractures. Fourteen patients had thigh pain (9.82%), and five had inner thigh pain (3.07%); seven had more severe pain that was improved by physical therapy.

Conclusion: PFNA-II has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures. However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.

Show MeSH
Related in: MedlinePlus