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A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II

Siddhant Sanjay Gandhi, Santosh S Nandi, Sandeep Naik, Shreepad Kulkarni, Gireesh Khodnapur

Abstract: Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60 to 50. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome.Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.
Keywords: fracture / functional outcome / score / rotation system / PFNA II / system II / anti rotation / nail anti

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