Tag Archive for: Inter-trochanteric fractures

To Evaluate The Outcome of Proximal Femoral Nail A2 in Management of Inter-trochanteric Fractures of Femur in Elderly

Vol 7 | Issue 1 | January-June 2021 | page: 01-04 | Karuna Shankar Dinkar, Rohit Yadav, Arjun Uppal, Chandra Prakash Pal, Mayur Gupta

Author: Karuna Shankar Dinkar [1], Rohit Yadav [1], Arjun Uppal [1], Chandra Prakash Pal [1], Mayur Gupta [1]

[1] Department of Orthopaedic Surgery, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.

Address of Correspondence
Dr. Chandra Prakash Pal,
Professor and Head Dept. of orthopedics, S. N. Medical College, Agra, Uttar Pradesh, India.
E-mail: drcportho@gmail.com


Introduction- The incidence of inter-trochanteric fracture in the elderly is rising because of increased age and with low bone mineral density. The presence of osteoporosis in inter-trochanteric fractures is important because the fixation of the proximal fragment depends entirely on the quality of the cancellous bone present. The surgical stabilization of inter-trochanteric fractures remains a persistent challenge. The purpose of this study is to study the effectiveness and drawbacks of one such newer intramedullary device, Proximal Femoral Nail Antirotation in the management of inter-trochanteric fractures.

Material and method- Patients who underwent PFNA for inter-trochanteric fractures at a tertiary care center Agra, who have given written and informed consent. Patients fitting into inclusion criteria would form the study group. Data collected by interviews, observation of clinical and radiological findings and assessment of function done using Harris hip score.

Results- The study comprised 24 patients, with a mean age of mean age 63 years who suffered fracture inter-trochanteric femur, due to either trivial fall (75%) or RTA (17%) and managed by cephalomedullary nailing using Proximal Femoral Nai Antirotation at our center. The majority of the patients had the quality of reduction; the Majority of patients took 12 to 22 weeks for union with mean union time of 14 weeks. Patients were asked to follow up routinely, with post-operative follow up ranging from a minimum of 11 months to 18 months. At the final follow up following results obtained according to Harris Hip Score, were 55% patients excellent, 30.50% patients good, 12% patients fair, 2.50% patients poor.

Conclusions- The inter-trochanteric fracture in elderly patients treated with cephalomedullary nailing using proximal femoral nail-anti-rotation, which has the biomechanical advantage of the helical blade providing bone compaction, increasing surface area and better anchorage in the femoral head, which showed favorable outcome by retarding rotation and varus collapse and prevents medialization by acting as a central pillar.

Keywords- Inter-trochanteric fractures; Proximal femoral nail A2; Harris Hip Score.


1. Kaufer H. Mechanics of the Treatment of Hip Injuries. Clin Orthop. 1980;146:53 -61.
2. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty – two intertrochanteric hip fractures. A retrospective and prospective study. J Bone Joint Surg. 1979;61A: 216 – 21.
3. Kaufer H, Mathews LS, Sonstegard D. Stable Fixation of Intertrochanteric Fractures. J Bone Joint Surg. 1974;56A:899 – 907.
4. Sommers MB, Roth C, Hall H, Kam BC, Ehmke LW, Krieg JC,et al. A laboratory model to evaluate cutout resistance ofimplants.
5. Sadic S et al. Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Hip Fractures:a Retrospective Study in 113 Patients Med Arh. 2015 Dec; 69(6): 353-356.
6. Jin-Song Pu & Lei Liu & Guang-Lin Wang & Yue Fang & Tian-Fu Yang Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients International Orthopaedics (SICOT) (2009) 33:1441–1444 DOI 10.1007/s00264-009-0776-3.
7. Chaoliang Lv, MD;Yue Fang, MS; Guanglin Wang,MD; Tianfu Yang, BS; Hui Zhang, MD; Yueming Song,MD. The New Proximal Femoral Nail Antirotation Asia: Early Results. Orthopaedics:10.3928/1477447-20110317-26
8. Sahin S, Ertürer E, Oztürk I, Toker S, Seçkin F, Akman S. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation (PFNA) in the treatment of unstable intertrochanteric femoral fractures. Acta Orthop Traumatol Turc. 2010;44(2):127-34. doi: 10.3944/AOTT.2010.2237.for pertrochanteric fracture fixation. J OrthopTrauma. 2004;18(6):361–8.5
9. Kumar GN et al. Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients the Open Orthopaedics Journal, 2015, 9, 456-459
10. Jacobs RR, McClain O, Armstrong H J. Internal fixation of intertrochanteric hip fractures: a clinical and biomechanical study. Clin Orthop. 1980; 146:62 –70.
11. Simpson AH, Vart y K, Dodd C A. Sliding hip screws: modes of failure. Injury. 1989;20:227 – 31.

How to Cite this article: Dinkar KS, Yadav R, Uppal A, Pal CP, Gupta M | To Evaluate The Outcome of Proximal Femoral Nail A2 in Management of Inter-trochanteric Fractures of Femur in Elderly | Trauma International | Jauary-June 2021; 7(1): 01-04.


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