A study to evaluate the functional and radiological outcome of proximal femoral nail Anti rotation 2 in inter trochanteric fractures of femur

Abstract

Introduction: Fractures around the trochanteric area of the femur are among the most frequent fractures encountered in orthopaedics, especially in geriatric population and increasing life expectancy has resulted in increase in these type of fractures. Aim: The aim of this study was to analyze the functional and radiological outcome of patients treated with PFN A-II. Methods: Patients presenting with unstable intertrochanteric femur fracture (AO classification) and Singh’s index ≤ 3 were included. The study included 70 patients (30 males and 40 females), at our institution during the period of July 2019 to December 2020. Clinical outcome was measured in terms of procedure time, clinical function at each follow-up and mortality. Radiographic evaluation was measured by quality of reduction, Cleveland Index, tip-apex distance (TAD), and time for the union. Complications including delayed union, non-union, screw backing out , screw cut through into the joint, infection, osteonecrosis of the femoral head, and implant breakage were also investigated. Results: All the 70 patients included in the study were treated with PFN A-2. The average age of the patients included was 74.4 years . The TAD was more than 25mm in 8 patients. 11 patients has sub optimal position of the implant as per cleveland index. Outcome was excellent in 45, good in 15, fair in 7,poor in 3, and this is based on modified Harris hip score with the minimum follow-up period being 6 months. The difference between the neck shaft angle of the operated side when compared with the un-injured side is more than 10 * in 11 patients. The average union time was 5.6 weeks, average modified Harris hip score was 86.5. Conclusion: The result of our study shows that PFNA2 is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation in the osteoporotic patients , which allows early full weight bearing mobilization of the patient.