Proximal femoral nail antirotation (PFNA) for treatment of osteoporotic proximal femoral fractures

Unstable trochanteric fractures have been an enigma for the orthopedic surgeon in the community because of unpredictable results. Cephalic intramedullary nails with proximal antirotation device are the treatment of choice for such patients. To report outcomes of 36 consecutive patients treated with a proximal femoral nail (PFNA) for osteoporotic trochanteric femoral fractures. The patients included 20 men and 16 women, aged 55-78 years (mean 65.3 years) years with trochanteric/proximal femoral fractures, which underwent PFNA fixation using an intramedullary nail and a spiral blade into the femoral head. We used AO system of classification of the fractures. Pertrochanteric (31 A1 and 31 A2), intertrochanteric fractures (31 A3), and high subtrochanteric (32 A1) fractures were included in the study. We had 16 A2 fractures, 12 A3 fractures, and 6 A1 fractures and 2 cases of 32 A1 fractures. 31 A2 was the commonest type. The operative time, the overall fluoroscopy time, intraoperative blood loss, the duration of hospitalization, and the surgical complications were noted. Patients were followed up for a mean of 24 months (range 18-36 months). Functional outcomes were assessed according to the Harris hip scoring system. One patient required open reduction. The mean duration of surgery was 45 min (range 25-55 min). The mean image intensifier usage time was 70 ms with a range between 44 and 98 ms. The mean time of hospital stays was 5 days (4-10). Postoperative radiographs showed good reduction in 32 cases (out of 34) or acceptable in the 2 cases. There were three postoperative complications (one myocardial infarction, one patient developed DVT, and one patient developed bedsore). There were no cutouts of the spiral blade. Two patients expired due to medical illness unrelated to the fracture. All 34 patients available for follow-up had healed fractures without any implant-related complications, such as bending, breaking, or implant cutout. The average bone healing time was 18 weeks (12-22 weeks). At the time of the latest follow-up, all the 34 patients were full weight bearing on affected site, with return to their preinjury activity level. The mean Harris hip score was 96.4 points (range 69-100 points). A total of 32 patients had excellent or good outcome, and 2 patients had satisfactory outcome and none had poor outcome. PFNA is useful for the treatment of osteoporotic proximal femoral fractures, and our initial experience suggest that it has low implant-related complications.