Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures

BACKGROUND The preferred treatment of intertrochanteric fractures in aged patients is controversial. The purpose of the present study was to evaluate the outcomes of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for stabilization of such fractures. METHODS The PFNA-II was used to treat intertrochanteric fractures in 163 elderly patients from March 2010 to March 2013. The patients comprised 69 men and 94 women with a mean age of 74.7 ± 13.0 years. All fractures were classified by the Orthopaedic Trauma Association classification system; 53, 83, and 27 fractures were classified as 31A1, 31A2, and 31A3, respectively. We statistically evaluated the intraoperative blood loss, operation time, incision length, X-ray exposure time, and postoperative outcomes. Patients were followed up for a mean of 15.2 months (range, 10-24 months). Functional outcomes were assessed according to the Harris hip scoring system. RESULTS Statistical analysis revealed an average operation time of 45.7 min (range, 35-110 min), average intraoperative blood loss of 115.2 mL (range, 65-430 mL), X-ray exposure time of 2.7 ± 1.4 s (range, 2-6 s), and total incision length of 6.5 ± 2.2 cm (range, 5.5-13.0 cm). Patients were followed up for a mean of 14.5 months (range, 10-24 months). The neck shaft angle was 134° ± 15° (range, 115°-150°), and the fracture healing time was 14.0 ± 2.5 weeks (range, 11-19 weeks). The Harris hip score was 85.6 ± 17.5 points (range, 65-100 points) and included 41 excellent cases (25.15%), 92 good cases (56.44%), 26 moderate cases (15.95%), and 4 poor cases (2.45%) for a positive outcome rate of 81.60%. There were no varus hip deformities, screw cutouts, or femoral shaft fractures. Fourteen patients had thigh pain (9.82%), and five had inner thigh pain (3.07%); seven had more severe pain that was improved by physical therapy. CONCLUSION PFNA-II has the advantages of a simple operation, few complications, and clinical efficacy for the treatment of intertrochanteric fractures. However, evaluation of its long-term efficacy and risk of other complications requires a large-sample, multicenter observational study.