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National Journal of Clinical Orthopaedics
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2021, Vol. 5 Issue 1, Part B
Comparative study of efficiency of PFN vs PFNA-II (Asian) in Intertrochanteric femur fracture with deficient lateral wall- A prospective interventional study
Author(s): Pavith T Janardhan and Manjunath S Japatti
Abstract: 
Background: Proximal femoral nail is the gold standard for many peri trochanteric fracture. Being a load bearing device and intramedullary implant theoretically it is superior than DHS. Lateral wall integrity is the major concern for varus collapse of fixation. Some recent studies reported many PFNA induced lateral wall blow out during insertion. PFNA II came with modifications to prevent these complications during insertion. PFN also has many complications like z effect, screw cut-out, migration and reverse z effect, varus collapse in deficient lateral wall. Hence, we conducted this study to analyse the efficiency of PFN vs PFNA II in lateral wall deficient unstable intertrochanteric fracture.
Methods: It is a prospective interventional study involving 50 patients with intertrochanteric fracture having deficient lateral wall. Study conducted at our institution during 2017-2019. Patients were randomized into two groups of 25 each using computer-based randomization to be treated with PFN or PFNA-II. Post operatively followed at regular intervals and analyzed radiographically and functionally using x ray and Harris hip score respectively.
Results: The average time to union radiologically was 25.2 weeks and 20.18 weeks for PFN and PFNA-II group respectively. The mean HHS accounted for 85.64 in PFN group and 88.45 in PFNA-II group at the end of study. In this study 12 patients had excellent HHS, 8 patients with good HHS, 3 fair HHS and 2 patients with poor HHS in PFN group whereas 14 patients have excellent HHS, 9 patients with good HHS, 1 fair and 1 patient with poor HHS in PFNA-II group. In PFN two patients suffered surgical site infection, two patients progressed to have varus collapse and screw backout. In PFNA II one patient had helical blade cut through. These failed implants patients underwent revision surgery.
Conclusions: single helical blade with ability to create visible compression and impaction at fracture site has a clear advantage over PFN having two screws to be passed through deficient lateral wall. End cap with locking helical blade within the nail prevents its backout and reduces complications related to it. PFNA II is better than PFN in lateral wall deficient intertrochanteric femur fracture.
Pages: 114-117  |  658 Views  114 Downloads
How to cite this article:
Pavith T Janardhan, Manjunath S Japatti. Comparative study of efficiency of PFN vs PFNA-II (Asian) in Intertrochanteric femur fracture with deficient lateral wall- A prospective interventional study. Nat J Clin Orthop 2021;5(1):114-117 DOI: https://doi.org/10.33545/orthor.2021.v5.i1b.305
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