Proximal femoral nail antirotation in treatment of fractures of proximal femur.

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Abstract

[Indexed for MEDLINE] 10. Hip Pelvis. 2017 Jun;29(2):113-119. doi: 10.5371/hp.2017.29.2.113. Epub 2017 Jun 2. Clinical Results of Complex Subtrochanteric Femoral Fractures with Long Cephalomedullary Hip Nail. Kim KK(1), Won Y(1), Smith DH(2), Lee GS(1), Lee HY(3). Author information: (1)Department of Orthopaedic Surgery, College of Medicine, Konyang University, Daejeon, Korea. (2)Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA. (3)Changwon Fatima Hospital, Changwon, Korea. PURPOSE: Good results of the cephalomedullary nails have been reported in proximal femoral fractures recently. Based on length of nails and shape of screws fixed in a femoral head for proximal fragment fixation, the proper nail length was in dispute. The purpose of this study was to evaluate the clinical and radiological results of a long cephalomedullary hip nail for the treatment of comminuted subtrochanteric femoral fractures. MATERIALS AND METHODS: Twenty-one consecutive patients with severe subtrochanteric femoral fractures who had undergone intramedullary fixation using long-PFNA II between March 2010 and March 2013 were followed-up for over 12 months. Their mean age was 64.8 years old (range, 43-85 years). Sixteen of 22 cases were high energy trauma. According to Seinsheimer's classification, 5 cases were type IV and 16 cases were type V. For radiological assessment, time to union, change of neck-shaft angle, sliding length, tip-apex distance (TAD) and leg length discrepancy (LLD) were measured. For clinical evaluation, a modified Koval index was investigated. RESULTS: Mean operation time was 96 minutes. An average decrease of neck-shaft angle was 4.5°. The average sliding length of the helical blade was 4.2 mm. Average LLD was 3.0 mm, and TAD was 23.0 mm. Mean modified Koval index score at final follow-up was 4.6 points. All the 21 subtrochanteric fractures healed uneventfully on an average of 24.2 weeks (range, 18-30 weeks). CONCLUSION: Long cephalomedullary hip nail provides excellent clinical and radiological outcomes in the comminuted subtrochanteric fracture. DOI: 10.5371/hp.2017.29.2.113 PMCID: PMC5465392