Proximal femoral nail antirotation in treatment of intertrochanteric femoral fractures in elderly patients

Objective To evaluate the clinical efficacy of proximal femoral nail antirotation( PFNA) in the treatment of intertrochanteric femoral fractures in elderly patients. Methods PFNA was performed in 34 patients( 15 cases were male and 19 cases were female) with intertrochanteric fractures. There were 12 cases caused by traffic accident,17 by tumbles,and 5 by other causes. Preoperative ASA: grade Ⅰ 5 cases,grade Ⅱ 11 cases,grade Ⅲ 15 cases and grade Ⅳ 3 cases.The surgical procedure time,intraoperative blood loss and perioperative complications were recorded and compared. All patients received the regular outpatient reexamination and X-ray examination 4 weeks,12 weeks,6 months and 12 months after the operations,to determine the healing time of fractures and get Harris hip score. The patients with Harris score of90 or more was as excellent,90- 80 was as good,70- 79 as fine,less than 70 as poor. Results The operation incision was 3- 5 cm with an average of 4 cm. The operation time was 36- 115 min,with an average of( 49. 3 ± 9. 8) min. The amount of bleeding in operation was 50- 200 ml with an average of( 108. 3 ± 20. 3) ml,fracture healing time was 63- 182 d with an average( 102. 0 ± 4. 6) d. After the operation,only 1 case was with internal fixation loosening,all the other patients were without complications. After the operation,the joint function by Harris score: 24 cases were excellent,7 cases good,2 cases fine,and 1 case poor,with the fine rate of 91. 2%. The early functional exercise,such as sit up and turn over within 24 hours after the operation,hip flexion,get out of bed,walk with stick and other weight-bearing exercise were carried out. Conclusion PFNA for intertrochanteric fractures in elderly patients is effective,with less amount of bleeding and complications,it is worthy of clinical promotion.