Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?

Purpose: We evaluated the geometric discrepancies between the proximal femur in Koreans and two types of proximal femoral nail using plain radiographs.

Materials and methods: A total of 100 consecutive patients (38 treated with proximal femoral nail antirotation [PFNA], 62 PFNA II) with intertrochanteric fracture were retrospectively identified. The minimum follow up period was 32 months. The geometric analysis of the proximal femur was performed using preoperative true hip antero-posterior radiographs of the unaffected side, and the data were compared with the PFNA and PFNA II dimensions. Postoperative assessments were performed using postoperative radiographs for the proximal protruding length of nail tip, quality of reduction, implant position and the presence of lateral cortical impingement.

Results: The geometric dimensions of the proximal femur were different between the two proximal femoral nail types. No impingement was detected in patients treated with PFNA II, whereas 13 cases of lateral impingement were observed in patients treated with PFNA. A significant association was observed between the short proximal femur and the presence of lateral cortical impingement (P=0.032) and between impingement and intraoperative reduction loss (P=0.012). Proximal protrusion of the nail tip was seen in 71 patients and no difference was observed between two groups.

Conclusion: Our study demonstrates that the flat lateral surface of PFNA II can avoid lateral cortical impingement, which provide better fixation for intertrochanteric fracture. However, there was still a problem associated with longer proximal end of PFNA II compared with the proximal femoral length in Korean.