THE OUTCOME OF PROXIMAL FEMORAL NAIL ANTIROTATION – II (PFNA-II) IN INTERTROCHANTERIC FEMUR FRACTURES IN A KASHMIRI POPULATION

Background: Intertrochanteric fractures are relatively common injuries in adults and a common source of morbidity and mortality among the elderly. Incidence of fractures is increasing because the general life expectancy of the population has increased significantly during the past few decades. Stable fixation and early mobilization is needed in these fractures to reduce morbidity and mortality. OBJECTIVES: To evaluate the functional and radiological outcome of the operative management of intertrochanteric femur fractures with PFNA-II. STUDY DESIGN: Prospective observational study. PARTICIPANTS: 30 patients with intertrochanteric femur fractures meeting the inclusion criteria. METHODS: After seeking approval from institutional Ethical committee, this study was conducted on patients attending our emergency department with intertrochanteric femur fractures at SKIMS Medical College Hospital Bemina, Srinagar from February 2018 to june 2019. Informed and written consent was obtained from all the patients in urdu language. The functional outcome was assessed at 6 months follow up using the Harris Hip Score. RESULTS: Based on the Harris Hip Score, 18 (60%) patients had Excellent results, 10 (33%) had Good results and 2 (7%) had Fair results. None of the patients had Poor result. Average time to union was 12.27 weeks. CONCLUSION: This study found the PFNA-II to be a versatile, easy to use and dependable implant in intertrochanteric fractures. It involves less dissection, preservation of fracture hematoma, less blood loss and fewer complications. PFNA-II is an ideal implant for stable as well as unstable intertrochanteric fractures and is a distinct advance over the previous methods of treatment, though it has an initial learning curve. IMPLICATIONS: Regular usage of the PFNA-II is restricted due to relatively higher cost which acts as a deterrent in developing countries like India. So, appropriate selection of patients can help in proper utilisation of resources. As most of the implant related complications occur in elderly patients. So, use of PFNA-II, particularly in elderly patients for intertrochanteric fractures can decrease the overall burden of such fractures.