Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur
ORIGINAL ARTICLE Published online: 31/05/2014 Published print: 06/2014
doi: 10.5455/medarh.2014.68.173-177 Med Arh. 2014 Jun; 68(3): 173-177 Received: February 28th 2014 | Accepted: May 05th 2014 © AVICENA 2014
Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur Sahmir Sadic1, Svemir Custovic1, Mahir Jasarevic1, Mirsad Fazlic1, Nedim Smajic1, Asmir Hrustic1, Aleksandar Vujadinovic1, Ferid Krupic2 Orthopedic and Traumatology Clinic, University Clinical Centre, Tuzla, Bosnia and Herzegovina 1 Department of Orthopedic, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Corresponding author: Sahmir Sadic MD. PhD. Orthopedic and Traumatology Clinic, University Clinical Centre, Trnovac 1. Tuzla, Bosnia and Herzegovina. Phone: 0038761333346. E-mail: [email protected].
ABSTRACT Introduction: Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. Material and methods: We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6±11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). Results and discussion: The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p=0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2±7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6±5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p=0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p=0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p=0.0001). Conclusion: PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient. Key words: fracture, femoris, PFNA, mobility.
1. INTRODUCTION Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Incidence of fractures is increasing, which is not unexpected because the general life expectancy of the population has increased significantly during the past few decades. Nearly nine of 10 hip fractures occur in patients older than 65 years old. Fractures of the upper part of the thigh bone (femur) are termed hip or proximal femoral fractures. Roughly half of all hip fractures are ’extracapsular’ in that they lie outside the hip joint capsule. Extracapsular hip fractures are defined as those fractures that occur within the area of bone bounded by the attachment of the hip joint capsule and extending down to a level which is five centimeters below the distal (lower) border of the lesser trochanter (1). Many of the patients have significant comorbidities, which lead to delays in surgery and functional recovery. These patients should be mobilized as soon as possible to prevent complications associated with immobilization. Therefore, a surgical technique allowing anatomic Med Arh. 2014 Jun; 68(3): 173-177
alignment and a stable fixation with early mobilization is accepted as the standard approach for intertrochanteric fractures. Surgeon can control of fracture reduction, implant selection and implant placement, all of which must be optimized to ensure the success of the surgical intervention. Operative treatment of hip fractures was introduced in the 1950s. Many methods have been recommended for the treatment of intertrochanteric fractures. Implants may be either extramedullary or intramedullary in nature. The most commonly used extramedullary implant is the sliding hip screw. A number of different designs have been developed and marketed by different manufacturers. Examples include the Gamma nail (Stryker-Howmedica), the intramedullary hip screw (Smith and Nephew Richards), the proximal femoral nail (Synthes) and the ACE trochanteric nail (DePuy Orthopaedics). PFNA, designed by AO in 2004, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head (2, 3). In this study, we aimed to assess the results of osteosynthesis using the PFNA system, (Synthes, Switzerland), 173
Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur
in the treatment fractures of the proximal femur included operative and postoperative complications, general complications and final outcome measurements.
2. STATISTICAL ANALYSIS Data were analyzed using: Chi-Square, proportions and Wilcoxon test. For all tests, p values
ORIGINAL ARTICLE Published online: 31/05/2014 Published print: 06/2014
doi: 10.5455/medarh.2014.68.173-177 Med Arh. 2014 Jun; 68(3): 173-177 Received: February 28th 2014 | Accepted: May 05th 2014 © AVICENA 2014
Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur Sahmir Sadic1, Svemir Custovic1, Mahir Jasarevic1, Mirsad Fazlic1, Nedim Smajic1, Asmir Hrustic1, Aleksandar Vujadinovic1, Ferid Krupic2 Orthopedic and Traumatology Clinic, University Clinical Centre, Tuzla, Bosnia and Herzegovina 1 Department of Orthopedic, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Corresponding author: Sahmir Sadic MD. PhD. Orthopedic and Traumatology Clinic, University Clinical Centre, Trnovac 1. Tuzla, Bosnia and Herzegovina. Phone: 0038761333346. E-mail: [email protected].
ABSTRACT Introduction: Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Many methods have been recommended for the treatment of intertrochanteric fractures. Material and methods: We retrospective analyzed all the patients with fractures of the hip treated with proximal femoral nail antirotation (PFNA) at the Clinic of Orthopedic and Traumatology, University Clinical Centre Tuzla from the first of January 2012 to 31 December 2012 years. The study included 63 patients averaged 73.6±11.9 years (range, 29 to 88 years). Fracture type was classified as intertrochanteric (Arbeitsgemeinschaft für Osteosynthesefragen classification 31.A.1, A.2 and A.3) and subtrochanteric fractures (Seinsheimer classification). Results and discussion: The ratio between the genders female-male was 1.6:1. There was statistically significant difference prevalence of female compared to male patients (p=0.012). There were 31 left and 32 right hip fractured. Low energy trauma was the cause of fractures in 57(90.5%) patients. Averaged waiting time for hospitalization was 3.2±7.5 days (range, 0 to 32 days). 44 patients were admitted the same day upon injuring. The average waiting time for the treatment was 3.6±5.7 days. The ratio between with or without co-existent disease was 4.7:1. During the three months postoperatively with ASA score 3 and 4 six patients died. There were no significant differences in deaths from ASA score 1 and 2 (p=0.52). Reoperation for the treatment of implant or fracture-related complications was required in three (4.7%) patients (infection, reimplantation and extraction). Three patient developed deep vein thrombosis. Statistically significant difference was found in the deaths in the first three months compared to the next three months (p=0.02). We found statistically significant difference between pre-injury and postoperative mobility score (p=0.0001). Conclusion: PFNA is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation, which allows early full weightbearing mobilization of the patient. Key words: fracture, femoris, PFNA, mobility.
1. INTRODUCTION Fractures of the proximal femur and hip are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Incidence of fractures is increasing, which is not unexpected because the general life expectancy of the population has increased significantly during the past few decades. Nearly nine of 10 hip fractures occur in patients older than 65 years old. Fractures of the upper part of the thigh bone (femur) are termed hip or proximal femoral fractures. Roughly half of all hip fractures are ’extracapsular’ in that they lie outside the hip joint capsule. Extracapsular hip fractures are defined as those fractures that occur within the area of bone bounded by the attachment of the hip joint capsule and extending down to a level which is five centimeters below the distal (lower) border of the lesser trochanter (1). Many of the patients have significant comorbidities, which lead to delays in surgery and functional recovery. These patients should be mobilized as soon as possible to prevent complications associated with immobilization. Therefore, a surgical technique allowing anatomic Med Arh. 2014 Jun; 68(3): 173-177
alignment and a stable fixation with early mobilization is accepted as the standard approach for intertrochanteric fractures. Surgeon can control of fracture reduction, implant selection and implant placement, all of which must be optimized to ensure the success of the surgical intervention. Operative treatment of hip fractures was introduced in the 1950s. Many methods have been recommended for the treatment of intertrochanteric fractures. Implants may be either extramedullary or intramedullary in nature. The most commonly used extramedullary implant is the sliding hip screw. A number of different designs have been developed and marketed by different manufacturers. Examples include the Gamma nail (Stryker-Howmedica), the intramedullary hip screw (Smith and Nephew Richards), the proximal femoral nail (Synthes) and the ACE trochanteric nail (DePuy Orthopaedics). PFNA, designed by AO in 2004, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head (2, 3). In this study, we aimed to assess the results of osteosynthesis using the PFNA system, (Synthes, Switzerland), 173
Proximal Femoral Nail Antirotation in Treatment of Fractures of Proximal Femur
in the treatment fractures of the proximal femur included operative and postoperative complications, general complications and final outcome measurements.
2. STATISTICAL ANALYSIS Data were analyzed using: Chi-Square, proportions and Wilcoxon test. For all tests, p values
