PFNA Research Articles

Clinical observation of proximal femoral anti-rotation nail internal fixation in the treatment of intertrochanteric fracture

Objective To evaluate the clinical effect of proximal femoral nail anti-rotation Ⅱ(PFNA Ⅱ) internal fixation in the treatment of intertrochanteric fracture. Methods From September 2012 to April 2016, the clinical data of 37 patients with intertrochanteric fracture who were treated by PFNAⅡ internal fixation in Yuehua Hospital were retrospectively analyzed. Results All 37 patients were successfully operated, and the operation time was 40~120 min, with an average of 66 min.The amount of blood loss was 30~110 mL, with an average of 50 mL.During operation and after operation, X ray showed a good position and steady internal fixation.Three days after operation, patients exercised diseased side hip joint.Seven days after operation, patients exercised sitting on the bed.Fourteen days after operation, suture was dismantled and patients could get out of bed and walk with no weight or some weight.Lower limb deep venous thrombosis(DVT) was not observed.Through operative multiple reexamination, the fracture was healed and hip joint function was good. Conclusion PFNA Ⅱ has advantages of convenient operation, less trauma, stronger internal fixation, rapid recovery.It is an ideal method to treat intertrochanteric fracture. Key words: Femoral fractures; Fracture fixation, intramedullary; Bone nails; Haemorrhage; Complication

Study on the characteristics of recessive hemorrhagic loss and related factors in the treatment of intertrochanteric fracture in elderly patients with PFNA

Objective To analyze the characteristics and influencing factors of recessive hemorrhagic loss of intertrochanteric fracture in elderly patients with PFNA. Methods The clinical data of 120 elderly patients with IFF from January 2011 to December 2017 in Rizhao Central Hospital were retrospectively analyzed.The dominant blood loss, hidden blood loss and total blood loss after PFNA were calculated, and the influencing factors were analyzed. Results The total blood loss of 120 elderly patients with intertrochanteric fractures was (911.4±240.8)mL, the dominant blood loss was (255.7±89.7)mL, occult blood loss was (679.5±208.6)mL, the hidden blood loss was significantly greater than the dominant blood loss, the difference was statistically significant (t=8.669, P 75, the preoperative use of anticoagulant drugs, unstable fracture and diabetes were the independent risk factors of hidden blood loss of PFNA (OR=2.254, 1.676, 0.753, 0.965, 2.625, all P<0.05). Conclusion Recessive blood loss is the main cause of loss of blood in patients with intertrochanteric fracture of the femur treated with PFNA.Hypertension, surgery after injury delayed more than 5d, aged more than 75 years, the preoperative use of anticoagulant drugs, unstable fractures and diabetes are risk factors of hidden blood loss of PFNA. Key words: Femoral fractures; Fracture fixation, intramedullary; Blood loss, surgical; Aged

Bundles of care prevents postoperative delirium in elderly patients with hip fractures

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures. Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017. The patients were divided into experimental group (n=43) and control group (n=37) according to the random number table method. The experimental group received bundles of care, while the control group received routine nursing. The patients in both groups were all surgically treated, and the confusion assessment method (CAM) was applied to diagnose delirium after surgery. Gender, age, fracture type, duration from injury to operation, internal fixation type, operation time, total amount of bleeding, visual analogue scale (VAS), incidence of delirium, complications, and adverse events were compared between the two groups. Results Among the 80 patients, there were 11 males and 69 females, aged averagely 79.3 years (range, 65-95 years). No significant differences were found between experiment group and control group in terms of gender (male: 6 cases vs. 5 cases, females: 37 cases vs. 32 cases), age [(79.8±7.8)years vs. (78.7±8.9)years], cause of injury (traffic injuries: 7 cases vs. 4 cases; falling injuries: 36 cases vs. 33 cases), duration from injury to operation [(66.1±14.3)hours vs. (63.4±14.9)hours], fracture type (femoral neck: 13 cases vs. 10 cases; intertrochanteric: 26 cases vs. 24 cases; subtrochanteric: 4 cases vs. 3 cases), internal fixation type (artificial total hip: 5 cases vs. 5 cases; artificial femoral head: 8 cases vs. 5 cases; PFNA: 29 cases vs. 27 cases), operation time[(55.5±16.8)minutes vs.(51.6±17.0)minutes], total blood loss [(114.4±73.9)ml vs.(108.1±72.0) ml](P>0.05). After bundles of care intervention, the postoperative VAS [(2.2±0.8)points vs. (4.3±1.2) points], postoperative delirium incidence (9% vs. 32%), incidence of complications and adverse events (2% vs. 19%) in experimental group were significantly lower than those in control group (P<0.05). Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium, complications, and adverse events in elderly patients with hip fracture. Key words: Hip fractures; Delirium; Aged; Care bundle

Proximal femur locking plate fixation for the treatment of unstable femoral intertrochanteric fractures in elderly patients

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed. There were 56 males and 64 were females, aging from 62 to 78 year-old (average, 69.4 year-old). 85 cases were left hip, and 35 cases right hip. According to AO fracture classification, there were 12 cases of A2.2, 23 A2.3, 34 A3.1, 29 A3.2, and 22 A3.3. According to Evans intertrochanteric fractures classification: there were 93 cases of type III, 19 type IV, and 8 type V. Operation time, length of hospital stay, fracture healing time, postoperative complications and hip joint Harris scores were recorded. Results All patients were followed up for 8-14 months (average, 12.4 months). Their operating time were 51-80 min (average, 63.1 min); X-ray exposure were 8-15 times (average, 11.6 times); intraoperative blood loss were 70-120 ml (average, 92.7 ml); postoperative drainage volume were 50-100 ml (average, 61.7 ml), and length of hospital stay were 7-14 d (average, 10.2 days). The healing time ranged from 12 to 32 weeks (20.4 weeks average). 14 cases had delayed union, and healing time was 8-10 months. In addition, 4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized); 2 had internal fixation broken, who were then treated with PFNA II, and bone healed after 6 months; 5 had hip varus, who were then treated via hip replacement, and no hip prosthesis fracture were found. No other complications occurred in the remaining patients. At the latest follow-up, according to Harris hip score: there were 38 cases with excellent results, 71 good, 9 fair, and 2 poor, and the rate of excellent and good was 90.8% (109/120). Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion, less complication, reliable fixation and high fracture healing rate, thus it is suitable for unstable intertrochanteric fractures in elderly patients. Key words: Aged; Hip; Fractures, bone; Fracture fixation, internal

Treatment with total hip arthroplasty for the failure of stable(3.1A1) femoral intertrochanteric fractures surgery using proximal femoral nail antirotation or dynamic hip screw

Objective To investigate the clinical effect of total hip arthroplasty in the treatment of failure of femoral intertrochanteric fractures(3.1A1.1-3) with proximal femoral nail antirotaion or dynamic hip screw. Methods A retrospective study was performed on 192 patients(192 hips) underwent total hip arthroplasty(THA) to cure failed femoral intertrochanteric fractures surgery using proximal femoral nail antirotation or dynamic hip screw from January 2007 to April 2016.The preoperative and postoperative data,from the reasons for internal fixation failure,imaging changes,improved Harris score and postoperative complications were analyzed. Results The scores of Harris in each group were significantly higher than those before operation(P<0.05). There was no significant difference between the two groups.There were more postoperative complications in the DHS group compared with PFNA group,and the difference was statistically significant(P<0.05). Conclusion The total hip arthroplasty in the treatment of femoral intertrochanteric fractures with proximal femoral nail or dynamic hip screw failure has good clinical results.The postoperative complications are more likely to occur in patients with DHS for the first time,there is no significant difference between the two prostheses of bone cement and non-bone cement. Key words: Femoral intertrochanteric fracture; Total hip arthroplasty; Dynamic hip screw; Proximal femoral nail antirotaion

Evaluation of Suitability of River Water for Multipurposes by Assessing Various Indices

The present research has evaluated the suitability of river water near industrial area of Dhaka for multi uses by calculating various indices. A considerable variation in the content of physicochemical and toxic elements in the studied river water suggests input of pollution from different sources. Further, excess concentration of Fe, Al and K compared to WHO standard was observed in Turag, Pb, Fe, Al, Cr and K in Buriganga, Cd, Fe, K, Al and Cr in Shitalakhya, Fe, Al and K in Bongshi and As in Dhaleswari river water. Moreover, all the river water is found to be safe for irrigation with respect to pH, TDS, SAR and MR. However, the metal pollution indices PF, PD, PLI and irrigation indices Na% and KI indicates that Buriganga river water is no longer suitable for the use of any purposes. But water of Turag, Shitalakhya and Bangshi River still can be used by controlling the source of pollution through proper treatment of waste or by preventing any further discharge of waste into the river. On the other hand Dhaleswari river water can be used for all purposes. Moreover, from the toxicity distribution pattern, it is seen that Buriganga > Shitalakhya > Bangshi > Turag > Dhaleswari. Therefore, proper management plan is necessary to protect this invaluable resource for multi use.

Lateral decubitus versus supine position in treatment of intertrochanteric fractures with proximal femoral nail antirotation

Objective To compare the lateral decubitus and supine position in the treatment of femoral intertrochanteric fractures with femoral proximal nail antirotation (PFNA). Methods A retrospective analysis was performed of the 85 patients with intertrochanteric fracture who had been treated at our hospital between September 2013 and September 2014. They were 24 men and 61 women, 28 to 99 years of age (average, 78.5 years). By Evans-Jensen classification, one case was type Ⅰ, 15 cases were type Ⅱ, 40 type Ⅲ, 23 type IV, and 6 type V. All the patients were treated with internal fixation with PFNA. Lateral decubitus position was adopted in 45 cases and supine position in 40. The 2 groups were compared in terms of operation time, intraoperative bleeding volume, difference between preoperative and postoperative hemoglobin values, tip-apex distance (TAD), calcar tip-apex distance (Cal-TAD), fracture healing time, and Harris score of the hip joint. Results The 85 patients were followed up for 9 to 21 months (average, 13.6 months). Both 2 groups obtained fracture healing, with no screw cut-out. The lateral decubitus group had significantly less operation time (60.3±17.5 min) and intraoperative bleeding volume (70.8±37.8 mL) than the supine position group (72.7±19.7 min and 90.3±20.9 mL, respectively) (P 0.05). Conclusion In the treatment of femoral intertrochanteric fractures with PFNA, lateral decubitus position may be associated with shorter operation time and less intraoperative blood loss compared with supine position. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Position

Causes for failed internal fixation of femoral intertrochanteric fracture in senile patients

Objective To investigate the causes and countermeasures of failed internal fixation of femoral intertrochanteric fracture in the senile patients. Methods From September 2008 to June 2014, 96 patients with femoral intertrochanteric fracture were operated on using varied internal fixations. These patients were 42 males and 54 females in age range of 65-98 years (mean, 72.5 years). There were 19 Evans type Ⅰ, 32 type Ⅱ, 25 type Ⅲ, 16 type Ⅳ and 4 type Ⅴ fractures. Internal fixation methods, failure causes as well as types, and failure incidence were analyzed. Results All the patients were followed up for 3 to 36 months (mean, 11.8 months). Totally 9 patients resulted in failed internal fixation, with the failure rate of 9% (2 stable and 7 unstable fractures). Failed internal fixations were proximal femoral nail antirotation (PFNA, n=2), anatomic plate fixation (n=3), locking plate osteosynthesis (n=8) and dynamic hip screw (n=1). Failure types were hip varus and shortening deformity because of incorrect operation and internal fixation breakage or loosening as the screws were not tightened during operation. Conclusion Osteoporosis, incorrect internal fixation methods, faulty operative procedures and postoperative rehabilitation are the most important factors responsible for the internal fixation failure for femoral intertrochanteric fracture in senile patients. Key words: Femoral fractures; Fracture fixation, internal; Internal fixation failure

Treatment of long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation

Objective To investigate the effects of long proximal femoral nail antirotation （PFNA-long） in treating long-segment fracture in middle-up part of femoral. Methods From June 2006 to December 2013, we treated 139 cases long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation （PFNA, 320-380 mm） by minimally invasive per-cutaneous fixation and autogenous iliac bone graft. Data of 139 patients （104 male and female 35;ages 18 to 86 years, with an aver-age age of 48.8 years）. Type IA 58 cases （41.73%, 58/139）, type IB 25 cases （17.99%, 25/139）, type IC 4 cases （2.88%, 4/139）, type II 28 cases （20.14%, 28/139）, type IIIA 12 cases （8.63%, 12/139）, type IIIB in 5 cases （3.60%, 5/139）, type IV 7 cases （5.04%, 7/139）. The duration from injury to surgery was 3 hours to 12 days, with an average of 4.2 days. The postoperative follow-up was at 1, 2, 3, 6, 9, 12 months, and annually at least. The clinical efficacy was evaluated with Harris hip function score. The postoperative pain was evaluated with visual analogue scale （VAS）. Results The operative time of 139 cases was from 35 to 90 minutes, averaged 45 minutes and the blood loss during surgery averaged 78.6 ml （ranged from 30 to 200 ml）. All patients walked by walking aid appliance after 4 to 10 days postoperatively, apart from 16 cases with serious long grinding fracture. All patients had been followed up for 3 to 37 months （mean 19 months）. No complications, such as infection, lower limb vein infarction, cut-out and breakage of the implants, occurred. However, there were 4 patients with nail broken and 6 patients with hip internal rotation who were treated by secondary operation. There were 5 cases with slight hip external rotation and 8 cases with hip internal reverse-lamb shortening malformation. All fractures healed after 2.8-6.8 months （mean 3.9 months）. According to Harris criteria, the clini-cal results were best in 108 cases, better in 22 cases, good in 8 cases, and bad in 1 case. The excellent and good rate was 93.53%（130/139）. The score for VAS was 0-6 （mean 0.8）, 93 cases in which no pain, mild pain in 33 cases, moderate pain in 13 cases, 25 cases occasionally need to take non-steroidal analgesics. Conclusion Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment fracture in middle-up part of femoral, with higher strength in fixation, higher rate of fracture union, early functional recovery and lower rate of complications. Key words: Femoral fractures Fracture fixation; intramedullary Internal fixators

Comparison of four methods of fixation for intertrochanteric fractures in elderly patients

Objective To compare the internal fixation methods for treatment of intertrochanteric fractures in elderly patients. Methods One hundred and sixty four elderly patients with intertrochanteric fractures were treated from June 2006 to September 2011. The fractures were fixed with dynamic hip screws (DHS, n=42), locking proximal femur plate (LPFP, n=40), Gamma nails (n=36) or proximal femoral nail anti-rotation (PFNA, n=46), respectively. The clinical data were collected and the operative time, blood loss, time of clinical healing, postoperative complications and Harris hip scores of 6 months after surgery were compared among groups. Results All patients were followed-up for 6 to 36 months. The operative times of DHS, LPFP, Gamma nails and PFNA groups were (103±15), (90±13), (79±11) and (65±9) min, respectively (F=2.87, P<0.05). The blood loss of 4 groups was (202±23), (181±23), (98±13) and (87±11) ml, respectively (F=3.21, P<0.05). The times of clinical fracture healing were (16.1±1.9), (14.6±1.8), (12.9±1.7) and (11.5±1.4) weeks, respectively (F=2.66, P<0.05). The postoperative complications of 4 groups were 4/42, 3/40, 2/36 and 1/46, respectively (χ2=5.67, P<0.05). The Harris hip scores of 6 months after surgery of 4 groups were 81%(34/42), 85%(34/40), 89%(32/36) and 93%(43/46), respectively (H=20.03, P<0.05). Conclusions In treatment for intertrochanteric fractures in elderly patients, the efficacy of intramedullary fixation (Gamma nails and PFNA) is better than extramedullary fixation (DHS and LPFP). PFNA is more effective than other 3 methods and should be preferentially chosen. Key words: Femoral fractures, intertrochanteric; Fracture fixation, internal; Internal fixators; Comparative study

Russell-Taylor reconstruction nails versus PFNA in the treatment of osteoporosis intertrochanteric fracture

Objective To explore the efficacy of Russell-Taylor reconstruction nails versus that of PFNA in the treatment of intertrochanteric fractures.Methods The data on 86 patients receiving Russell-Taylor reconstruction nails or PFNA were retrospectively analyzed.The types of fracture,surgical duration,intraoperative bleeding volume,efficacy of the procedures,and complications were recorded.Results There were no significant differences between the two groups in surgical duration and intraoperative bleeding volume.The rate and quality of fracture healing differed significantly between the two groups.Conclusions Both Russell-Taylor reconstruction nails and PFNA are the effective method for intertrochanteric fractures of,but the former procedure has more advantage. Key words: Russell-Taylor reconstruction nails; PFNA; Intertrochanteric fractures

Study on minimally invasive treatment for femoral comminuted fracture of patients with proximal femoral nail anti-rotation

Objective To explore the effect application of minimally invasive treatment of proximal femoral nail anti-rotation on comminuted fracture fractures patients. Methods From July 2009 to May 2011,46 patients with femoral comminuted fracture were treated with PFNA. The hospitalized stay time, operation time, perioperative bleeding, fracture healing time, and hip joint function were statistically analyzed. Results The average follow-up duration was 9.3 months. The hospital stay was 15 days (range 14-20 days). The average operation time was 50 minutes (range; 30～90 minutes). The average perioperative bleeding was less than 100 ml. Fracture occurred in all patients with a mean healing time of 9 months. No deformity of hip was found. According to Harris hip score, we found excellent in 19eases, good in 24 cases and poor in 3 cases, with the excellent rate of 93.4%. Conclusion Minimally invasive treatment of proximal femoral nail can obtain good effect for the comminuted fractures patients. Key words: Proximal femoral nail anti-rotation; Comminuted; Femoral fractures; Minimally invasive

Clinical analysis of different treatment methods for femoral intertrochanteric fractures

Objective To investigate different surgical treatments for femoral intertrochateric fractures. To evaluate the results of treatment of intertrochateric fractures with PFNA. Methods 37 patients with femoral intertrochateric fracture were retrospectively reviewed,of which 12 patients were treated operatively with PFNA,25 patients were treated operatively with DHS. Therapeutic efficacy were compared and analyzed. Results All the patients were followed up for 5-18 months(an average of 11 months). All fractures healed in a mean of 3 months. According to Harris'standard of hip-joint fuction,the outcome was classified into excellent,good and poor. In 25 patients with DHS,the good clinical results was 21 cases. In 12 patients with PFNA, excellent and good clinical result was 11 cases. Conclusion PFNAintemal fixation was an effective method for treating the femoral intertrochateric fractures and better than that by DHS. Key words: Hip fractures; Fracture fixation, intramedullary

Clinical effective analysis of surgical methods on elderly intertrochanterie fracture

Objective To study the clinical efficacy in treatment of elderly patients with intertrochanteric fracture by the hollow nail plus DHS, or Gamma nail, or PFNA. Methods 150 cases of elderly patients with intertrochanteric fracture, according to three kinds of different fixation methods, were randomly divided into the hollow nail plus DHS group (54 cases), Gamma nail group (51 cases), and PFNA group (45 cases). Results According to Harris criteria scores, the rate of excellent and good effects in PFNA and Gamma nail groups are superior to that in hollow nail plus DHS group, the anterior postoperative functional recovery is also good; and the rate of excellent and good effects in PFNA group and Gamma nail group was no significant difference (P> 0.05). The bleeding volume, postoperation pain and failure ratio of internal fixation in Gamma nail and PFNA groups are less than that in hollow nail plus DHS group (P<0.05). Conclusion The methods of Gamma nail and PFNA fixation are simple, fixed firmly, less bleeding and excellent efficacy in treatment of elderly patients with intertrochanteric fracture, especially the unstable fracture of the intertrochanteric fracture. Key words: Intertrochanteric fracture; Internal fixation