Proximal Femoral Nail Antirotation Fixation Research Articles

Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures

Objective To explore the effect of cephalomedullary nails for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus zimmer natural nail (ZNN) to provide the data support for clinical perioperative management. Methods A retrospective study was used to analyze the clinical data of elderly intertrochanteric fractures cases which were treated with PFNA or ZNN fixation from May 2016 to May 2017. In the study, 59 cases were followed up completely, in which 28 cases accepted PFNA, and the other 31 cases accepted ZNN. The operation time, amount of bleeding, fracture healing time, postoperative complication, postoperative radiographic measurement (tip apex distance, TAD) and the last follow-up of hip function score were analyzed. Results The patients were followed up for 6 to 19 months, with an average (10.8±4.0) months. In PFNA group, the operation time was (62.7±14.2) min, the amount of bleeding was (56.8±20.6) mL, the fracture healing time was (4.6±0.8) months, the postoperative complication was 3.6%, the TAD was (17.7±5.5) mm, and the last follow-up hip function score was 91.8±3.6. In ZNN group, the operation time was (73.6±18.3) min, the amount of bleeding was (68.7±31.6) mL, the fracture healing time was (4.5±0.7) months, the postoperative complication was 3.2%, the TAD was (16.5±4.7) mm, and the last follow-up hip function score was 92.2±3.8. The two groups of comparative experiments were carried out, the operation time of the PFNA group was less than that of the ZNN group (P 0.05). Conclusion Although group ZNN had significant longer operation time than group PFNA, both implants were useful tools in the treatment of elderly intertrochanteric fractures. The operation of PFNA was simpler,while the design of the anterior bow of ZNN might be more suitable for the patients with a large femoral anterior bow.

Comparison of the clinical effects of proximal femoral anti-rotation nail and dynamic hip screw internal fixation in the treatment of elderly patients with intertrochanteric fracture

Objective To compare the effects of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) internal fixation in treating senile intertrochanteric fractures. Methods From January 2014 to March 2016, 100 elderly patients with intertrochanteric fracture in the Second People's Hospital of Yaodu District were selected and randomly divided into two groups according to the digital table, with 50 patients in each group.The PFNA group and DHS group were treated with PFNA and DHS internal fixation, respectively.The curative effect, fracture healing, complications and hip function scores were compared between the two groups. Results The treatment excellent rate of the PFNA group (92%) was significantly higher than 76% of the DHS group (χ2=4.762, P<0.05). The fracture healing time of the PFNA group was (15.37±6.29)weeks, which was significantly shorter than (23.64±8.17)weeks of the DHS group (t=5.671, P<0.05). The incidence rate of complications of the PFNA group (6%) was significantly lower than 22% of the DHS group ( χ2=5.316, P<0.05); .After surgery, the Harri hip scores of the PFNA group and DHS group were significantly higher than those before surgery (t=11.330, 5.788, all P<0.05), and the Harri hip score of the PFNA group after surgery was higher than that of the DHS group (t=5.147, P<0.05). Conclusion Compared with DHS, the clinical effect of PFNA internal fixation in the treatment of elderly patients with femoral intertrochanteric fractures is more significant. Key words: Femoral fractures; Fracture fixation, intramedullary; Internal fixators; Bone nails; Aged

Comparison of efficacy, complications and TGF-β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture.

The aim of the present study was to compare the efficacy and complications of two fixation techniques, namely dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA), in the treatment of osteoporotic femoral intertrochanteric fracture in elderly patients, and to detect changes in transforming growth factor β2 (TGF-β2) expression in the two groups. A total of 100 elderly patients with femoral intertrochanteric fracture were randomly divided into two groups that were treated with either DHS or PFNA. Peri-operative complications were observed in the patients and ELISA was used to detect TGF-β2 expression levels at 1, 7, 15 and 30 days after surgical treatment. The clinical efficacy and the incidence rate of complications at 3 months after the operation were compared. In comparison with the DHS group, the PFNA group had a shorter operation time, a lower bleeding volume and a shorter post-operative weight-bearing time. The contents of TGF-β2 in the two groups at 7 days after the operation were higher than those at 1 day, reached a peak at 15 days and had gradually decreased again at 30 days after the operation. The contents of TGF-β2 at 1, 7 and 15 days in the PFNA group were higher than those at the identical time-points in the DHS group (P<0.01). Regarding the clinical efficacy in the two groups at 3 months of post-surgery, the rate of excellent/good efficacy in the PFNA fixation group (90.0%) was higher than that in the DHS fixation group (74.0%). Of note, PFNA fixation had a higher clinical efficacy, a shorter operation time, less intra-operative trauma, a relatively faster fracture healing process and fewer complications in comparison with DHS fixation, and is therefore more suitable for treating osteoporotic femoral intertrochanteric fracture in the elderly. PFNA fixation is superior to DHS fixation, which may be associated with the higher level of TGF-β2 expression in comparison with that in the DHS group.

Treatment of femoral intertrochanteric fractures by reduction without a traction table in a special position and fixation with proximal femoral nail antirotation (PFNA)

Objective To study the treatment of femoral intertrochanteric fractures by reduction without a traction table in a special position and fixation with proximal femoral nail antirotation (PFNA). Methods From May 2016 to May 2017, 34 patients with femoral intertrochanteric fracture were treated with PFNA. They were 20 men and 14 women, from 36 to 89 years of age (average, 69.9 years). The left side was affected in 15 cases and the right side in 19. By AO classification, there were 10 cases of type AO 31-A1, 13 ones of type 31-A2, and 11 ones of type 31-A3. Two cases were complicated with other fractures, and 5 with internal system disease, 3 of whom had more than 2 concomitant diseases. Preoperative deep venous thrombosis was found in 2 cases. Surgery was performed for them between 2 and 8 days after injury (average, 3.7 days). Reduction was performed in a special position without a traction table. The duration of anesthesia, operation time, intraoperative hemorrhage, postoperative complications and hip function by Harris scores were recorded. Results For the 34 patients, the anesthesia time ranged from 57 to 85 min (average, 67.5 min), the operation time ranged from 28 to 65 min (average, 40.9 min), and the intraoperative hemorrhage from 80 to 150 mL (average, 110.6 mL). They received effective follow-up for 6 to 12 months (average, 8.4 months). All the fractures healed after 6 to 12 months(average, 7.2 months). No failure of internal fixation was observed during follow-ups. By the Harris scores at the final follow-up, the function of the affected hip was rated as excellent in 9 cases, as good in 21 and as fair in 4, giving an excellent to good rate of 88.2%. Conclusion In the treatment of femoral intertrochanteric fractures, reduction without a traction table in a special position and PFNA fixation may reduce anesthesia time, leading to satisfactory clinical outcomes. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Non-traction table; Special position

Clinical efficacy of lengthened proximal femoral nail antirotation versus Gamma nail in treatment of proximal femoral fractures combined with femoral shaft fractures

Objective To investigate the clinical efficacy of lengthened proximal femoral nail antirotation (PFNA) and Gamma nail treatment of proximal femoral fractures (including the intertrochanteric and inferior intertrochanteric area) combined with ipsilateral femoral shaft fractures. Methods A retrospective case control study was made on 68 cases of proximal femoral fractures combined with ipsilateral femoral shaft fractures received from January 2013 to October 2014. According to the operation mode, the patients were assigned to PFNA group (30 cases) and Gamma nail group (38 cases). Between-group differences were compared in aspects of surgical condition, treatment effect, Visual Analogue Scale (VAS), postoperative hip function (Harris score) and living ability (Barthel index). Postoperative complications were recorded as well. Results Duration of follow-up was 12-24 months [(20.8±1.9)months]. Incision length in PFNA group was (5.4±1.2)cm versus (7.3±1.7)cm in Gamma nail group (P 0.05). Conclusion In treatment of proximal femoral fractures combined with ipsilateral femoral shaft fractures, the lengthened PFNA fixation has advantages over Gamma nail in terms of minor trauma, rapid postoperative recovery and significant effect. Key words: Femoral fractures; Fracture fixation, internal; Proximal femoral nail antirotation

Steinmenn pins used to assist reduction in treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation

Objective To evaluate application of Steinmenn pins to assist reduction in the treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation(PFNA). Methods From February 2010 to June 2013, 38 unstable intertrochanteric fractures were treated by us. There were 23 men and 15 women, aged from 32 to 69 years. By Evans-Jensen classification, 18 cases were type Ⅲ, 13 type Ⅳ and 7 type V. They were divided into 2 groups (n=19). Group A received reduction on a traction bed assisted by Steinmenn pins plus PFNA fixation while group B received reduction only on a traction bed plus PFNA fixation. The 2 groups were compared in terms of fracture reduction, operation time, intro-operative blood loss, fracture healing time, and Harris scores one year postoperation. Results According to the evaluation system modified by Baumgaetner et al., the postoperative quality of fracture reduction was fine in 15 cases and fair in 4 in group A while it was fine in 9 cases, fair in 8 and poor in 2 in group B, showing a significant difference between the 2 groups (P 0.05). No cases of refracture, delayed union, nonunion, or avascular necrosis of the femoral head were reported. Conclusion In the treatment of unstable intertrochanteric fractures, compared with reduction only on a traction bed plus PFNA fixation, application of Steinmenn pins to assist reduction on a traction bed plus PFNA fixation may lead to better curative efficacy due to its limited invasion, simplicity and beneficial assistance in reduction. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Reduction; Steinmenn pins

Application of 3D printing fracture models in treatment of intertrochanteric fracture

Objective To report the application of 3D printing fracture models to assist the treatment of femoral intertrochanteric fracture using proximal femoral nail anti-rotation(PFNA)fixation. Methods From August 2014 to February 2015, 27 unstable intertrochanteric fractures were treated using PFNA. Of them, 12 used a 3D printing fracture model to assist the surgery and 15 did not. CT scanning was performed for the patients in 3D printing model group. Their anatomical data of . Dicom form were reconstructed into the . STL form data through M3D software. The 3D printing model was constructed using fused deposition modeling(FDM)technique. The length and diameter of the main screw and blade were measured based on the 3D printing prototyping before surgical planning. The 2 groups were compared in terms of operation time, intraoperative blood loss, postoperative drainage volume, hospital stay and Harris hip score at the final follow-up. Results No significant differences were found in the 3D printing model between surgical planning and actual operation in the respects of diameter of main PFNA screw(9. 42 ±0. 64 mm versus 9. 58 ±0. 16 mm), length of main PFNA screw(177. 50 ± 12. 90 mm versus 178. 33 ±20. 34 mm), or length of blade(84. 58 ±5. 94 mm versus 85. 42 ± 5. 57 mm)( P> 0. 05). The 27 patients obtained an average follow-up of 12. 4 months(from 10 to 16 months). The operation time(47. 8 ±5. 1 min), intraoperative blood loss(101.6±3.9 mL)and postoperative drainage volume(47. 3 ±5.9 mL)in the 3D printing model group were significantly less than those in the conventional group(61. 1 ±7. 5 min, 122. 3 ±9. 8 mL and 58. 6 ±6. 3 mL, respectively)(P 0. 05). Both groups obtained fine fracture union. No varus deformation of the hip joint or failure of implants was observed during the follow-up period. Conclusion 3D printing technique can manufacture an accurate model of intertrochanteric fracture, which may play an important role in improving efficiency and accuracy of reduction and PFNA fixation. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; 3D printing

Efficacy of proximal femoral nail antirotation fixation combined with zoledronic acid in treatment of osteoporotic intertrochanteric fracture

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with zoledronic acid and PFNA only in the treatment of osteoporotic intertrochanteric fracture in the elderly patients. Methods A retrospective analysis was made on 72 patients that completed the follow-up after PFNA for osteoporotic intertrochanteric fracture from November 2011 to May 2014. According to the application of zoledronic acid (5 mg, once a year) after PFNA, the patients were divided into study group (n=30) and control group(n=42). Bone healing and subsequent refracture were assessed with X-ray postoperatively. Harris hip score was recorded. Bone mineral density before operation and one year after operation were compared between the two groups. Adverse effect of zoledronic acid was recorded during hospitalization. Results Mean period of follow-up was 15 months (range, 12-26 months). One year after operation, Harris score, new fracture incidence, mean fracture union time were (82.65±6.24)points, 3%(1/30) and (14.26±2.24)weeks in study group, while (81.85±5.38)points, 14%(6/42) and (15.26±3.05)weeks in control group. There were no statistical differences between the two groups (P>0.05), but the subsequent fracture was higher in control group. One year after operation, lumbar and contralateral non-injury hip bone marrow density were (0.78±0.16)g/cm2 and (0.71±0.14)g/cm2 in study group , higher than (0.75±0.13)g/cm2 and (0.69±0.13)g/cm2 in control group (P<0.05). But there were no significant differences between the two groups before operation. All fractures were healed at postoperative 1 year. No intolerable adverse events occurred in study group. Conclusions PFNA is effective in the treatment of osteoporotic intertrochanteric fracture. In the meantime, the combination with zoledronic acid has no influence on bone healing while increasing bone mineral density, and may decrease the occurrence of subsequent fragile fractures. Key words: Diphosphonates; Osteoporotic fractures; Hip fractures; Treatment outcome

Comparison of efficacy of PFNA internal fixation and hemiarthroplasty in treatment of elderly unstable inter-trochanteric fractures

Objective To compare the clinical efficacy of proximal femoral nail anti-rotation （ PFNA ） fixation and hemiarthroplasty in the treatment of elderly unstable intertrochanteric fractures .Methods 72 cases with unstable intertrochanteric fractures were divided into the two groups by random number table ,each group had 36 ca-ses,the control group was given implementation of hemiarthroplasty while the observation group was given PFNA fixa -tion,the clinical therapeutic effect were compared between the two groups .Results It showed no significant differ-ence in operative time between the two groups （t =2.58,P〉0.05）;the blood loss of the observation group was （187.52 ±10.83）mL,which was significantly less than that of the control group （t=9.56,P〈0.05）,the load time of the observation group was （33.52 ±3.28）d,which was significantly more than that of the control group （t=10.31, P〈0.05）;there were no significant differences in the hip function excellent rate after 1 year and postoperative com-plication rate between the two groups （94.44% or 91.67%,11.11% or 8.33%,χ2 =2.01,1.69,all P〉0.05）. Conclusion PFNA fixation and hemiarthroplasty for treatment in elderly unstable intertrochanteric fractures have good effect ,and the patients should be based on the specific clinical circumstances , under strict control of surgical contraindications choose the right surgery . Key words: Femoral fractures; Fracture fixation,internal; Arthroplasty,replacement,hip

Cephalomedullary Nail versus Sliding Hip Screw for Unstable Intertrochanteric Fractures in Elderly Patients

To compare the short-term ambulatory function of elderly patients after fixation of unstable intertrochanteric fractures with either the AO-ASIF proximal femoral nail anti-rotation (PFNA) device or the dynamic hip screw (DHS). 63 patients aged 60 years or older underwent fixation for unstable intertrochanteric fractures (AO types A2 and A3) using the PFNA (n=25) or DHS (n=38). The decision for the type of implant used was based on the lead surgeon's preference, according to perceived fracture stability and clinical experience. In patients having PFNA fixation, weight bearing ambulation and rehabilitation was commenced on day 2. The extent of weight bearing was decided by the lead surgeon based on the stability of the fracture. In patients having DHS fixation, non-weight bearing and ambulation with a walking aid was commenced on day 2. Ambulatory function before injury and after surgery was measured using the Parker Mobility Score (PMS). The 2 groups were compared in terms of the PMS, ambulatory independence, and environmental mobility. Respectively in PFNA and DHS patients, 32% and 13% (p=0.035) were ambulant with a walking frame at discharge; the remainder were wheelchair bound. Patients treated with PFNA had significantly higher median PMS at 6 months (4 vs. 2, p=0.002), median ambulatory independence score at 6 months (4 vs. 3, p=0.004) and at 12 months (5 vs. 4, p=0.001), and median environmental mobility score at 6 months (2 vs. 1, p=0.007). They also had significantly higher percentage of patients able to ambulate outdoor and in community at 6 months (64% vs. 29%, p=0.02) and able to walk independently or with a walking aid at 12 months (96% vs. 69%, p=0.01). There were 3 complications. Two patients treated with PFNA had blade cut-out, owing to poor fracture reduction. One patient treated with DHS had screw cut-out and subsequently developed avascular necrosis of the femoral head. Unstable intertrochanteric fractures in elderly patients with good pre-fracture ambulatory function stabilised with the PFNA resulted in better short-term ambulatory function.

Analysis of therapeutic efficacies on Proximal Femoral Nail Anti-rotation(PFNA)in the treatment of 35 elderly patients with intertrochanteric fractures of femur

Objective To analyze the theropeutic effects of treatments with proximal femoral nail antirotation(PFNA)in senile people with intertrochanteric fractures of femur.Methods From February 2008 to January 2009.35 senile patient with femoral intertrochanteric fracture received fixation of PFNA were analyzed retrospectively.Results Two cases died of cardiovascular and cerebrovascular disease and two cases were not followed up.The 31 cases were followed up from 12 to 23 month after operation(average18.2 months).Bone union,range from 8 weeks to 16 weeks(average 12.8 weeks),was obtained in the 31 cases.2 case of sliding out with screw blade,which lead thigh pain,were observed.According to the Harris criterion.The excellent rate of hip function was 87.8%.Conclusion PFNA fixation technique is a good method for treatment of elderly patients with femoral intertrochanteric fracture. Key words: Proximal Femoral Nail Anti-rotation; Intertrochanteric Fracture; Internal Fixation

Proximal femoral nail anti-rotation for unstable femoral intertrochanteric fractures In senile patients

Objective To evaluate the clinical effects of proximal femoral nail anti-rotation (PFNA) in treating femoral intertrochanteric fractures in the aged patients. Methods Under the guidance of flu-oroscopy, closed reduction, minimally invasive incision and percutaneous PFNA fixation were applied to treat 41 old patients with femoral intertrochanteric fracture from June 2006 to August 2008 in our hospital. They were 12 males and 29 females, with an average age of 74. 3 (67 to 92 years) years. According to Evans-Jensen classi-fication, there were 11 cases of ⅡA, 24 ⅡB, and 6 Ⅲ. Postoperative hip functions were evaluated by Harris system. Results The patients were followed up for 17.2 (6 to 31) months averagely. Fracture union was achieved in all patients with a mean healing time of 12. 5 (10 to 17) weeks. The postoperative Harris score was excellent in 26 cases, good in 13 and fair in 2. The total excellent to good rate was 95.1%. No in-fection, coxa vara, external rotation or shortening deformity, cut-out, fracture of femoral shaft, internal fix-ation failure or bone nonunion occurred. Conclusion Since PFNA fixation has advantages of less inter-ference with blood circulation at the fracture ends, little osseous destruction, simple operation, limited inva-sion, less blood loss, anti-rotation, stable fixation and few postoperative complications, it is an effective treatment for femoral intcrtrochanteric fractures in senile patients. Key words: Hip fracture; Fracture fixation, intramedullary; Treatment outcome