Original Research Article
Year: 2017 | Month: February | Volume: 4 | Issue: 2 | Pages: 56-62
PFNA-II in Peritrochanteric Femur Fractures: Experiences in Osteoporotic Elderly Indians
Dr. Srinivas Kasha1, Dr. Sameer Rathore2, Dr. Harpreet Singh Suri2, Dr. Anand Swamy3, Dr. Lokesh Naik G4, Dr. Sharma Gaurav Mahesh5
Department of Orthopaedics, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003,
3Clinical Assistant, Bhakti Vedanta Hospital, Mira Road, Mumbai, India.
4DNB Orthopaedics, 5D-Ortho, M.S. Orthopaedics,
Clinical Associate, Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana Samaj, Girgaon-400004, Mumbai, Maharashtra, India.
Corresponding Author: Dr. Lokesh Naik G
Background: Management of peritrochanteric fractures in elderly osteoporotic requires stable fixation with early mobilisation as elderly patients suffer high complication rate due to associated co-morbidities and recumbency. PFNAII is a relatively newer implant with the biomechanical advantage of helical blade providing bone compaction and better anchorage in femur head.
Patients and Methods: In this case series, we evaluated functional outcome of PFNAII in fixation of peritrochanteric fractures, with an average follow up of 22 months, in osteoporotic elderly Indians patients. Patients with pathological fracture, open fracture, multiple injuries, age less than 60 years, Patients with previous hip surgeries and non affordable for implants were excluded. 78 patients aged>60 years were operated with PFNAII. 46 fractures were unstable. 69 patients had one or more co-morbidities. 70 patients had osteoporosis of Grade I, II or III as per Singh’s Osteoporotic Index.
Results: Post-operatively 72/78 patients had acceptable alignment. All the patients were mobilized early. Post-operative morbidities were minimal. Average time to union was 14+/- 3 weeks. 50 patients recovered pre-op mobility by end of 6 months. There were no cases of varus collapse, blade cut out, nail fracture and non-union. 6 patients had asymptomatic backing out of blade. Anterior thigh pain occurred in 4 patients, 16 patients had abductor lurch while walking.
Conclusion: In surgeon’s experience, procedure was easy to perform with minimal intraoperative and post-operative complications. Efficacy of implant is good. Cost is a limiting factor for routine usage. As the implant provides exceptional advantage in osteoporotic bones, appropriate selection of patients can help in proper allocation of resources.
Key words: Geriatric hip fracture, Peritrochanteric/Intertrochanteric fracture, PFNA II, Helical Blade, Osteoporosis.[PDF Full Text]