Abstract

Abstract Background: Majority of trochanteric fractures occur in older age groups.e best options of internal xation for unstable intertrochanteric fractures in elderly patients remain controversial. e Asia proximal femoral nail antirotation (PFNA-II) was specically designed for Asian patients, which could be more effective than the regular proximal femoral nail antirotation (PFNA). Here we aim to report the clinico-radiological and functional outcomes of patients with proximal femoral fractures with PFNA-II With Antirotation screw. Materials and methods: From JAN 2017 to MAY2018 , 110 stable and unstable intertrochanteric fracturs treated with PFNA-II(Synthes, Solothurn, Switzerland) at Our Institute, were followed prospectively. Clinical and radiographic examinations were conducted in Follow-up at 1,3 AND 6 months. e quality of the fracture reduction was graded as poor (>10° deformation), acceptable (5° to 10° deformation), or good (<5° deformation). e fracture reduction was evaluated on the rst post-operative radiograph using fracture (mm) gap measurement. e fracture gap was classied as good (0-3 mm); acceptable (3-5 mm); or poor (> 5 mm) . Tip apex distance (TAD) was used to evaluate the placement of helical blade in the femoral head. Augmentation done to PFNA-2 with anti-rotation screw in 72 patients AND only PFNA- 2 used in 38 patients. Statistical analysis was performed to compare the results in both groups. e operative time, intraoperative blood loss, overall time of uoroscopy, length of hospital stay and postoperative complications were recorded. Functional outcome measured by Harris Hip Score. Results: e average duration of surgery(PFNA-II with antirotation) was 50.01 minutes , Fracture reduction was acceptable in 96.4% cases. Implant position was optimal in 99(90.0%) patients, Tip apex distance <20 in 95(86.36%) . Augmentation done to PFNA-2 with anti-rotation screw in 72 patients AND only PFNA- 2 used in 38 patients. Average Harris hip score at 6 months was 86.43. Harris hip score was excellent in 39(35.5%) patients , good in 50(45.5%) patients , fair in 16 (14.5%), poor in 5(4.5%) patients. Good functional outcome by Harris hip score is high in group of patients treated with PFNA-2 with antiroation screw (statistically signicant p <0.05) than groups of PFNA-2. Mean union time of fracture is 3.16 months .Union time is less (statistically signicant p<0.05) in case of fractures treated with PFNA-2 with antirotation screw than only PFNA-2 groups. Conclusions: All above results suggest that PFNA-Asia is effective and safe and beer implant with low complications rate in the treatment of stable and unstable intertrochanteric fractures in elderly indian patients with osteoporosis. But when used with augmentation with antirotation screw yields excellent results in form of good functional outcome and less union time.

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