Abstract
BackgroundThe proximal femoral nail anti-rotation Asia (PFNA 2) is an implant designed for unstable osteoporotic intertrochanteric fractures in Asians as the PFNA was designed for Caucasians and had various complications when applied to the Asian population due to the femoral geometrical mismatch. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population.MethodsSixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with PFNA 2 were included in this prospective observational study. They were followed up for one year. The functional and radiographic evaluations were done at 6, 12, 20 weeks, and the functional outcome was evaluated at the end of one year. Association of age, American Society of Anaesthesiologists (ASA) grade, AO Foundation classification, osteoporosis to the functional outcome of modified Harris hip score (MHHS) was evaluated.ResultsType A2 fractures demonstrated a statistically higher-good reduction than Type A3 (Student t-test, P < 0.05). The difference in mean surgical duration in Type A3 (45.47 minutes) and Type A2 (40.30 minutes) was statistically significant (Student t-test, P < 0.05). Mean blood loss was 110.66 ml (SD = 48.40 ml). MHHS at 6, 12, 20 weeks, and one year were 40.37, 63.93, 79.03, and 82.34, respectively. At the end of the year, 46 (82.1%) patients achieved good scores, eight (14.3%) achieved fair scores, and two (3.5%) achieved poor scores. There was one case of nonunion and medial migration of the helical blade. The mortality rate was 6.55% at the end of one year.ConclusionA good reduction was associated with a better functional outcome. PFNA 2 is an efficient implant in managing unstable intertrochanteric fractures in elderly Indian patients with good outcomes, low morbidity rates, and mortality. Implant mismatch was not a problem in the Indian population. However, large multi-centric studies with a larger sample size are required. Moreover, achieving a good reduction cannot be over-emphasized in unstable intertrochanteric fractures, especially in the elderly, to achieve a good functional outcome.
Highlights
Intertrochanteric hip fracture is a major public health problem in the geriatric age group
Sixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with proximal femoral nail anti-rotation (PFNA) 2 were included in this prospective observational study
Fracture reduction was achieved on the fracture table and surgical fixation of the fracture done with PFNA II (Proximal Femoral Nail Anti-rotation Asia, Synthes, Switzerland)
Summary
Intertrochanteric hip fracture is a major public health problem in the geriatric age group. Indian population is at higher risk of osteoporosis and associated hip fractures [1]. Hip fractures are common in this group of population and 50% of hip fractures in elderly patients are intertrochanteric of which more than 50% are of unstable type [3]. Hip fractures are associated with the risk of urinary tract infections, pneumonia, bedsores, and thromboembolic complications. They cause physical impairment, reduce the quality of life, and cause significant mortality. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population
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