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Original Article Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture
Soo Jae Yim, Yong Bok Park, Hyun Kwon Kim, Sin Hyung Park
Journal of Musculoskeletal Trauma 2020;33(4):210-216.
DOI: https://doi.org/10.12671/jkfs.2020.33.4.210
Published online: October 31, 2020
Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

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Abstract

Purpose
This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures.
Materials and Methods
From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared.
Results
The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012).
Conclusion
The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.


J Korean Fract Soc. 2020 Oct;33(4):210-216. Korean.
Published online Oct 22, 2020.
https://doi.org/10.12671/jkfs.2020.33.4.210
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Original Article

Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture

Soo Jae Yim, M.D., Yong Bok Park, M.D., Hyun Kwon Kim, M.D. and Sin Hyung Park, M.D.
    • Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
  • Correspondence to: Sin Hyung Park, M.D. Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea. Tel: +82-32-621-6706, Fax: +82-32-621-6950, Email: greatsin@empal.com
Received June 22, 2020; Revised June 30, 2020; Accepted October 08, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study compared the clinical and radiographic results of two proximal femoral nail anti-rotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures.

Materials and Methods

From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared.

Results

The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012).

Conclusion

The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.

Keywords
Femur intertrochanter fracture, Proximal anti-rotation femoral nail, Lateral thigh pain

Figures

Fig. 1
The blade insertion site of the proximal femoral nail anti-rotation II with 125° caput-collum-diaphyseal (CCD) angle was more superior and lateral than that with the 130° CCD angle if the targeting point of the blade is the same center point of the femoral head because of the different CCD angle.

Fig. 2
Distance between the blade insertion site and the tip of the greater trochanter (a).

Fig. 3
Distance between the blade insertion site and the most lateral protrusion point of the greater trochanter (b).

Tables

Table 1
Comparison of Preoperative Demographics between Two Different Caput-Collum-Diaphyseal Angle PFNA Groups

Table 2
Clnical Results of Surgery

Table 3
Radiographic Results of Surgery

Notes

Financial support:None.

Conflict of interests:None.

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    Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture
    J Korean Fract Soc. 2020;33(4):210-216.   Published online October 31, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.4.210
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