A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II.

Abstract

Background Unstable, comminuted intertrochanteric fractures continue to pose a challenge to the orthopedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anesthesia. For treatment of these unstable intertrochanteric fractures, PFNA was designed by AO in 2004. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60to 50.The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome. Aim To evaluate the functional and radiological outcome of unstable intertrochanteric fracture, treated PFNA-II in our population. Materials and methods This study is conducted between 1st November 2018- 31st may 2020 among 32 patients who were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail antirotation system II. All patients were followed up for minimum of 6 months. Functional outcome was assessed with modified haris hip score and radiological outcome was assessed with TAD score and implant related complications. DocuSign Envelope ID: 8904577AA94E833B--F18EE538--448320C6-8B42F08-370A3013F89DD5D96939EC9 xi Results Fracture union was appreciated on an average 4 months of postoperative period.4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified harris hip score, excellent outcome in 37.5% patient, good outcome in 43.8% patients, fair outcome in 12.5% patients, poor in 6.3 cases was noted. Conclusion From our study, we have come to the conclusion that PFNA II is a reliable implant for treatment of unstable intertrochanteric fractures leading to high rate of union restoring the anatomical alignment and reduced chance of implant failure