Abstract
We evaluated the clinical results of the proximal femoral nail anti-rotation (PFNA) for proximal femoral fractures.
Sixty-eight patients (16 men and 48 women, mean age 79.8 years) were treated with PFNA between November 2006 and May 2009. All cases were classified using the AO classification : 31 as A1, 24 as A2, 9 as A3, and 4 as B2.
The average tip-apex distance (TAD) was 15.0 mm. At the latest follow-up, the average sliding length of the PFNA blade was 4.9 mm. In 10 cases (of excessive sliding), the sliding length was over 10 mm.
There was no severe impairment of walking ability. All cases showed bone union without head rotation or neck varus deformity. There were no postoperative episodes of cut-out, infection, or deep venous thrombosis.
There was no relationship between TAD, AO classification, and excessive sliding of the PFNA blade. We evaluated trochantric fracture using Utsunomiya’s classification, which divides cases into the intramedullary type and the extramedullary type. In the present cases, the average length of the PFNA blade was 6.2 mm [7 cases (26.9%)] for the intramedullary type and 3.6 mm [2 cases (5.1%)] for the extramedullary type. The intramedullary type showed greater sliding than the extramedullary type.
We concluded that the PFNA procedure gave very satisfying results for internal fixation of hip fracture, and that Utsunomiya’s classification was useful for prediction of excessive postoperative sliding.
