Outcomes of Ipsilateral Femoral Neck and Shaft Fractures Treated With Proximal Femoral Nail Antirotation 2

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Nov 10

PMID 34754671

Citations 4

Authors

Rajesh Rana

Himansu Behera

Sudarsan Behera 2nd

Amrit G

Madho Singh

Affiliations

Soon will be listed here.

Abstract

Ipsilateral femoral neck and shaft fractures are relatively rare fractures, which most commonly occur in young adults following high-energy trauma. In most cases of such fractures, neck fracture is undisplaced and often of basicervical type. Many treatment methods have been described, but there is still no generalized consensus on the same. Cephalomedullary nails are one of the preferred modalities of treatment. A cephalomedullary nail-like proximal femoral nail antirotation 2 (PFNA 2) of recent design is being widely used currently. In this study, we present 13 cases of ipsilateral femoral neck and shaft fractures treated with PFNA 2 implants. The advantages of the PFNA 2 system include reduced blood loss, reduced operative time, and fewer fluoroscopy shots. PFNA 2 is a biomechanically better implant than many cephalomedullary implants. It provides satisfactory results in ipsilateral femoral neck and shaft fractures, especially where neck fracture is of a basicervical type. Some aspects have to be taken care of when employing PFNA 2, such as anatomical reduction, and length, angulation, and rotation of both neck and shaft.

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References

Wolinsky P, Johnson K . Ipsilateral femoral neck and shaft fractures. Clin Orthop Relat Res. 1995; (318):81-90. View

Singh N, Sharma V, Trikha V, Gamanagatti S, Roy A, Balawat A . Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population ? A prospective randomized study. J Clin Orthop Trauma. 2019; 10(Suppl 1):S71-S76. PMC: 6823828. DOI: 10.1016/j.jcot.2019.02.004. View

Okcu G, Aktuglu K . Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures. A retrospective review of 25 cases, with a follow-up of 36-150 months. Arch Orthop Trauma Surg. 2003; 123(10):544-50. DOI: 10.1007/s00402-003-0584-y. View

Guo J, Dong W, Jin L, Yin Y, Zhang R, Hou Z . Treatment of basicervical femoral neck fractures with proximal femoral nail antirotation. J Int Med Res. 2019; 47(9):4333-4343. PMC: 6753548. DOI: 10.1177/0300060519862957. View

Chen C, Chen T, Cheng Y, Chang J, Lin S, Hung S . Ipsilateral fractures of the femoral neck and shaft. Injury. 2000; 31(9):719-22. DOI: 10.1016/s0020-1383(00)00096-6. View

Mallya S, Kamath S, Madegowda A, Krishnamurthy S, Jain M, Holla R . Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis. Eur J Orthop Surg Traumatol. 2019; 29(5):1035-1042. DOI: 10.1007/s00590-019-02401-x. View

ALHO A . Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop Scand. 1996; 67(1):19-28. DOI: 10.3109/17453679608995603. View

Sharma A, Mahajan A, John B . A Comparison of the Clinico-Radiological Outcomes with Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) in Fixation of Unstable Intertrochanteric Fractures. J Clin Diagn Res. 2017; 11(7):RC05-RC09. PMC: 5583812. DOI: 10.7860/JCDR/2017/28492.10181. View

Oh C, Oh J, Park B, Jeon I, Kyung H, Kim S . Retrograde nailing with subsequent screw fixation for ipsilateral femoral shaft and neck fractures. Arch Orthop Trauma Surg. 2006; 126(7):448-53. DOI: 10.1007/s00402-006-0161-2. View

10.

Wu K, Lin S, Chou Y, Cheng H, Wen P, Lin C . Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series. J Orthop Surg Res. 2020; 15(1):20. PMC: 6971944. DOI: 10.1186/s13018-019-1524-z. View

11.

Harewood S, Mencia M, Harnarayan P . The rendezvous technique for the treatment of ipsilateral femoral neck and shaft fractures: A case series. Trauma Case Rep. 2020; 29:100346. PMC: 7413999. DOI: 10.1016/j.tcr.2020.100346. View

12.

Singh R, Rohilla R, Magu N, Siwach R, Kadian V, Sangwan S . Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol. 2009; 9(3):141-7. PMC: 2656981. DOI: 10.1007/s10195-008-0025-3. View

13.

Jones C, Walker J . Diagnosis and Management of Ipsilateral Femoral Neck and Shaft Fractures. J Am Acad Orthop Surg. 2018; 26(21):e448-e454. DOI: 10.5435/JAAOS-D-17-00497. View

14.

Huang F, Lin K, Yang S, Renn J . Comparative study of the proximal femoral nail antirotation versus the reconstruction nail in the treatment of comminuted proximal femoral fracture. Orthopedics. 2012; 35(1):e41-7. DOI: 10.3928/01477447-20111122-02. View

15.

Kiran Kumar G, Sharma G, Khatri K, Farooque K, Lakhotia D, Sharma V . Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients. Open Orthop J. 2016; 9:456-9. PMC: 4645863. DOI: 10.2174/1874325001509010456. View

16.

Fujii T, Nakayama S, Hara M, Koizumi W, Itabashi T, Saito M . Tip-Apex Distance Is Most Important of Six Predictors of Screw Cutout After Internal Fixation of Intertrochanteric Fractures in Women. JB JS Open Access. 2018; 2(4):e0022. PMC: 6133149. DOI: 10.2106/JBJS.OA.16.00022. View

17.

Barei D, Schildhauer T, Nork S . Noncontiguous fractures of the femoral neck, femoral shaft, and distal femur. J Trauma. 2003; 55(1):80-6. DOI: 10.1097/01.TA.0000046259.43886.25. View

18.

Cannada L, Viehe T, Cates C, Norris R, Zura R, Dedmond B . A retrospective review of high-energy femoral neck-shaft fractures. J Orthop Trauma. 2009; 23(4):254-60. DOI: 10.1097/BOT.0b013e31819a6651. View

19.

Peljovich A, Patterson B . Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg. 1998; 6(2):106-13. DOI: 10.5435/00124635-199803000-00005. View

20.

Sahin E, Imerci A, Kinik H, Karapinar L, Canbek U, Savran A . Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol. 2013; 24(3):347-52. PMC: 3958814. DOI: 10.1007/s00590-013-1195-0. View