Gavaskar Ashok Sunil, Subramanian Muthukumar, Tummala Naveen Chowdary
Consultant Surgeons, Department of Orthopedics and Trauma, Parvathy Hospital, Chennai, India.
Indian J Orthop. 2012 Sep;46(5):556-60. doi: 10.4103/0019-5413.101036.
The proximal femur nail antirotation (PFNA) is the recent addition to the growing list of intramedullary implants for trochanteric fracture fixation. The initial results in biomechanical and clinical studies have shown promise. We report our results of low velocity trochanteric fractures internally fixed by proximal femur nail antirotation.
A prospective study was conducted to assess the results of 122 elderly patients with low velocity trochanteric fractures [39 - stable (AO; 31-A1) and 83 - unstable (AO; 31-A2 and A3)] treated with PFNA from December 2008 to April 2010. Followup functional and radiological assessments were done. Results obtained were compared between stable and unstable fracture patterns using statistical tools.
The mean followup was 21 months (12-28 months). 11 patients were lost in followup. Union was achieved in all but one patient. Varus collapse was seen in 14 patients and helical blade cut out in one patient. Stable and satisfactorily reduced fractures had a significantly better radiological outcome. Functional outcome measures were similar across fracture patterns. 65% of the patients returned to their preinjury status. The overall complication rate was also significantly higher in unstable fractures.
Good results with relatively low complication rates can be achieved by PFNA in trochanteric fractures in the elderly. Attention to implant positioning, fracture reduction and a good learning curve is mandatory for successful outcomes.
股骨近端防旋髓内钉（PFNA）是用于转子间骨折固定的髓内植入物不断增加的列表中的最新成员。生物力学和临床研究的初步结果显示出前景。我们报告了使用股骨近端防旋髓内钉内固定治疗低速转子间骨折的结果。
进行了一项前瞻性研究，以评估2008年12月至2010年4月期间122例老年低速转子间骨折患者（39例稳定型骨折（AO；31-A1）和83例不稳定型骨折（AO；31-A2和A3））接受PFNA治疗的结果。进行了随访功能和放射学评估。使用统计工具比较稳定型和不稳定型骨折模式获得的结果。
平均随访时间为21个月（12 - 28个月）。11例患者失访。除1例患者外，所有患者均实现骨折愈合。14例患者出现内翻塌陷，1例患者出现螺旋刀片穿出。稳定且复位良好的骨折在放射学结果上明显更好。不同骨折模式的功能结果测量相似。65%的患者恢复到受伤前状态。不稳定骨折的总体并发症发生率也明显更高。
PFNA治疗老年转子间骨折可取得较好结果，并发症发生率相对较低。成功的结果需要注意植入物定位、骨折复位以及良好的学习曲线。
