Internal fixation with proximal femoral nail antirotation (PFNA) II for intertrochanteric fractures

Objective To investigate the clinical outcomes of proximal femoral nail antirotation (PFNA) Ⅱ in the treatment of femoral intertrochanteric fractures. Methods From January 2011 to June 2016 , 240 patients with intertrochanteric fracture were treated at our department. They were 132 males and 108 females, aged from 30 to 106 years (average, 71.4 years). Of them, 168 cases were older than 70 years. According to AO classification, 21 patients were of type 31-A1.1, 15 of type 31-A1.2, 27 of type 31-A1.3, 39 of type 31-A2.1, 51 of type 31-A2.2, 32 of type 31-A2.3, 12 of type 31-A3.1, 23 of type 31-A3.2 and 20 of type 31-A3.3. The time from injury to surgery in this series ranged from 38 to 140 hours, averaging 52 hours. All the patients were treated by fixation with PFNA Ⅱ. Results The average operating time was 45 min, average operation incision 5 cm, and average blood loss during operation 85 mL. Primary wound healing was achieved in 239 patients, and one patient developed postoperative incision infection which was cured after implants were taken out and debridement was carried out 8 weeks after operation. This group obtained an average follow-up of 31.5 months (from 6 to 51 months). Primary fracture healing was achieved in 235 patients after 6 to 23 weeks (average, 12.6 weeks); fracture healing was delayed in 5 patients after 36 to 96 weeks (average, 56 weeks). There was no in-hospital mortality, and the survival rate 6 months after operation was 98.8% (237/240). One year after operation, 132 patients obtained an average Harris hip score of 85.2 (from 72 to 94). No im-plant-related complications or implant failure happened. Conclusions Internal fixation with PFNA Ⅱ is an effective treatment for different types of femoral intertrochanteric fractures, because it is simple and less invasive, and leads to limited complications, especially for senile patients. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails