Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture.
OBJECTIVE
To retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation (PFNA).


METHODS
From September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type I fractures, 19 type II and 6 type III according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists (ASA), there were 9 grade I, 14 grade II, 8 grade III, and 4 grade IV.


RESULTS
The duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation (mean 3.5 days). Hospital stay was 4-7 days (mean 5.3 days). Full weight bearing time was 10-14 weeks (mean 12.8 weeks). During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks (mean 16.6 weeks). No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had trochanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.


CONCLUSIONS
The emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation, less blood loss, shorter length of stay, less complications, and the preliminary clinical effect is satisfactory.
Tang
Xin
X
Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Chengdu 6l0041, China.
Liu
Lei
L
Yang
Tian-fu
TF
Tu
Chong-qi
CQ
Wang
Guang-lin
GL
Fang
Yue
Y
Duan
Hong
H
Zhang
Hui
H
Pei
Fu-xing
FX
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D001858:Bone Nails; D004638:Emergency Treatment; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications