Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2
Published: April 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/47653.14751
OP Jamshad, Jacob Mathew, Raju Karuppal
1. Senior Resident, Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India.
2. Additional Professor, Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India.
3. Additional Professor, Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India.
Correspondence
Dr. Raju Karuppal,
Karuppal House, Post Mukkam-673602, Kozhikode, Kerala, India.
E-mail: drrajuortho@rediffmail.com
Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures.
Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients.
Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS).
Results: The mean follow-up period was 13 months (range, 12- 14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0.
Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).
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