Implant-Related Complications Following Proximal Femoral Nail Antirotation (PFNA) in Unstable Intertrochanteric Fractures – Early Follow Up

Abstract

INTRODUCTION; Intertrochanteric fractures present in a wide variety of patterns that range from simple to complex and may be minimally displaced or widely displaced. Unstable intertrochanteric fracture can fail due to mechanical problems, including loss of fixation, re-fracture, or implant failure. PURPOSE; The aim of this study was to analyse the failures in patients with unstable intertrochanteric femur fractures treated with short Proximal Femoral Nail Antirotation (Synthes) METHODS; A retrospective analysis of 97 patients with unstable intertrochanteric factures (AO : 31A2, n = 65 / 67.01 % ; 31-A3: n = 32 /32.9 %) treated with a PFNA in a self-contained district general hospital was conducted. RESULTS; The study included 25 (26%) males and 72 (74%) females with mean age of 82 years. The study period was over 12 months with mean follow up of 11 months (range 6 to 18 months). Intraoperative and postoperative radiographs showed good reduction in 80 patients, acceptable in 12 and poor in 3. Twenty patients had implant related complications, consequently ten patients (10.5 %) had to undergo revision surgery. The reasons of revision surgery were; Implant failures = 8 (8.4%), Helical Blade backing out =1( 1.05 %) and Greater trochanter splintering =1 (1.05%). CONCLUSION ; Implant related complications requiring revision occurred in 10 patients (10.5 %) in early follow up. Of those requiring revision 6 patients had highly unstable 31 A2.3 type fracture. Our study reinforces high failures in unstable intertrochantric fractures. Though Ideal implant remains elusive but Optimum intraoperative reduction and use of augments should be considered to improve outcomes.