Swaroop Shakti, Gupta Prateek, Bawari Rajesh, Marya Sanjiv K, Patnaik Swati
Orthopedics, Institute of Medical Sciences, SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, Bhubaneswar, IND.
Orthopedics, Max Super Specialty Hospital, Saket, Delhi, IND.
Cureus. 2020 Dec 8;12(12):e11973. doi: 10.7759/cureus.11973.
Background The proximal femoral nail anti-rotation Asia (PFNA 2) is an implant designed for unstable osteoporotic intertrochanteric fractures in Asians as the PFNA was designed for Caucasians and had various complications when applied to the Asian population due to the femoral geometrical mismatch. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population. Methods Sixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with PFNA 2 were included in this prospective observational study. They were followed up for one year. The functional and radiographic evaluations were done at 6, 12, 20 weeks, and the functional outcome was evaluated at the end of one year. Association of age, American Society of Anaesthesiologists (ASA) grade, AO Foundation classification, osteoporosis to the functional outcome of modified Harris hip score (MHHS) was evaluated. Results Type A2 fractures demonstrated a statistically higher-good reduction than Type A3 (Student t-test, P < 0.05). The difference in mean surgical duration in Type A3 (45.47 minutes) and Type A2 (40.30 minutes) was statistically significant (Student t-test, P < 0.05). Mean blood loss was 110.66 ml (SD = 48.40 ml). MHHS at 6, 12, 20 weeks, and one year were 40.37, 63.93, 79.03, and 82.34, respectively. At the end of the year, 46 (82.1%) patients achieved good scores, eight (14.3%) achieved fair scores, and two (3.5%) achieved poor scores. There was one case of nonunion and medial migration of the helical blade. The mortality rate was 6.55% at the end of one year. Conclusion A good reduction was associated with a better functional outcome. PFNA 2 is an efficient implant in managing unstable intertrochanteric fractures in elderly Indian patients with good outcomes, low morbidity rates, and mortality. Implant mismatch was not a problem in the Indian population. However, large multi-centric studies with a larger sample size are required. Moreover, achieving a good reduction cannot be over-emphasized in unstable intertrochanteric fractures, especially in the elderly, to achieve a good functional outcome.
股骨近端抗旋髓内钉亚洲版（PFNA 2）是一种专为亚洲人不稳定型骨质疏松性转子间骨折设计的植入物，因为PFNA是为高加索人设计的，应用于亚洲人群时由于股骨几何形状不匹配而出现了各种并发症。本研究观察PFNA 2治疗老年印度人群不稳定型转子间骨折的功能结果和并发症。方法：本前瞻性观察研究纳入61例60岁以上接受PFNA 2手术的不稳定型转子间骨折患者。对他们进行了为期一年的随访。在第6、12、20周进行功能和影像学评估，并在一年结束时评估功能结果。评估年龄、美国麻醉医师协会（ASA）分级、AO基金会分类、骨质疏松与改良Harris髋关节评分（MHHS）功能结果之间的关联。结果：A2型骨折的复位良好率在统计学上高于A3型（学生t检验，P<0.05）。A3型（45.47分钟）和A2型（40.30分钟）的平均手术时间差异具有统计学意义（学生t检验，P<0.05）。平均失血量为110.66 ml（标准差=48.40 ml）。第6、12、20周和一年时的MHHS分别为40.37、63.93、79.03和82.34。在一年结束时，46例（82.1%）患者获得良好评分，8例（14.3%）获得中等评分，2例（3.5%）获得差评分。有1例出现螺旋刀片骨不连和向内侧移位。一年结束时的死亡率为6.55%。结论：良好的复位与更好的功能结果相关。PFNA 2是治疗老年印度患者不稳定型转子间骨折的有效植入物，效果良好，发病率和死亡率低。植入物不匹配在印度人群中不是问题。然而，需要进行更大样本量的大型多中心研究。此外，对于不稳定型转子间骨折，尤其是老年患者，为了获得良好的功能结果，实现良好的复位再怎么强调也不为过。
