A prospective study to evaluate the clinical and functional outcomes in the management of unstable extracapsular proximal femoral fractures using proximal femoral nail with a helical blade construct (PFNA-II) at a tertiary care hospital

Author(s): Dr. Shreesh Bhaskarwar, Dr. Ghanshyam C Jagani, Dr. Arjun G Viegas, Dr. Jagdeesh B Panse, Dr. Ashish Desai and Dr. Vipul Kale

Abstract: Background: Extracapsular proximal femoral fractures are one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to trivial trauma. Presently, unstable extracapsular proximal femoral fractures are treated commonly with intramedullary nailing devices. Various designs of intramedullary nail are introduced. The conventional design has given diverse outcome and complications have also been noted with this implant. Newer designs like Proximal Femoral Nail Antirotation-II have been introduced for Asian population. There is paucity of the prospective studies on the effectiveness of PFNA-II system. Most have been retrospective studies and there are not much evidences regarding the postoperative complications in a long term. So a prospective study is needed to evaluate the effectiveness and long term problems if any with PFNA-II system and to modify the design further if required.
Aim and Objectives: To evaluate the clinical and functional outcomes in the management of unstable extracapsular proximal femoral fractures using proximal femoral nail with a helical blade construct (PFNA-II) at a tertiary care hospital.
Materials and Methods: A prospective study was undertaken in a Tertiary Hospital from April 2018 to April 2019, 30 patients (age >18 yrs) with extracapsular proximal femoral fracture i.e.AO type 31-A2 and type 31-A3 operated with PFNA-II. The patients were followed up at 6th week, 12th week and 6 months from the date of surgery. Clinical and Functional assessment was done using Harris Hip Score during follow up. X-ray was done at 12 weeks to assess the fracture healing, position of the implant and any complication. Data collected of these 30 patients were statistically analysed using SPSS (Statistical Package for the Social Sciences) version 16.0, IBM Corporation; NY, USA for MS Windows.
Results: The mean post-op (3 Months and 6 Months) Harris Hip score is significantly higher compared to the mean post-op (6 Weeks) Harris Hip Score (P-value<0.001 for all). The mean post-op (6 Months) Harris Hip score is significantly higher compared to the mean post-op (3 Month) Harris Hip Score (P-value<0.001). The mean% improvement in Harris Hip score from 6 Weeks to 3 Months, from 6 Weeks to 6 Months and from 3 Months to 6 Months is 66.91%, 111.09% and 26.54% respectively. Of 30 cases studied, 3 (10.0%) had reasonable functional outcome, 8 (26.7%) had good functional outcome and 19 (63.3%) had excellent post-op functional outcome at 6 months.
Conclusion: Unstable extracapsular proximal femoral fractures treated with PFNA-II with a helical blade construct has satisfactory clinical and functional outcomes with minimal complications and thus it is an excellent modality to treat unstable extracapsular proximal femoral fractures.

DOI: https://doi.org/10.22271/ortho.2022.v8.i1i.3082