Unstable inter-trochanteric femur fracture fixation with PFNA2: Does not require lateral wall fixation - A study of 278 patients

Abstract

Lateral wall fracture was considered to be one of the major contributors to failure when such fractures were routinely treated with Sliding hip screw. Later, several publications stressed that the Intramedullary device (IM) is the implant of choice in such cases. Hence PFNA2 became the implant of choice in Asian population for unstable IT fracture since the last decade. But failures With this background we have assessed our results of last 5 years where PFNA2 was the only implant used for all IT fractures irrespective of comminution and stability. Methods: This is a retrospective analysis of 309 patients with 3 part and 4 part stable and unstable IT fractures between June 2008 to June 2022 fixed with PFNA2 only, without additional fixation of the lateral wall. Results: All fractures united at an average of 14 weeks, without significant differences between the two groups (with and without lateral wall fracture). There was no statistically significant difference between the two groups with respect to TAD<20mm (p = 0.24), neck-shaft valgus angle at time of fixation (p = 0.31). There was no statistical significance between the two with respect to union rates, fracture collapse (p = 0.41), change in neck shaft angle (p = 0.11) and change in TAD (p = 0.44) between the surgery and at the time of union. Two patients presenting with implant failures (one done elsewhere) were revised and fixed with our technique with a PFNA2, without any lateral augmentation, both went on to unite well. Conclusion: Well aligned antero-medial cortex, coupled with a valgus reduction of the neck shaft angle, helical blade in centre-centre and TAD˂20mm, the fixation of lateral wall has no role in preventing the fracture collapse nor in the healing of an unstable IT femur fractures.

Keywords

• Intertrochanteric fracture
• Unstable
• Lateral wall
• Anteromedial cortex
• PFNA2