title: Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Hip Fractures: a Retrospective Study in 113 Patients.
abstract: BACKGROUND
  The best treatment for intertrochanteric fractures remains controversial. Many methods have been recommended.
  
  
  OBJECTIVE
  We aimed to assess the results of osteosynthesis using the Proximal Femoral Nail Antirotation (PFNA) system.
  
  
  METHODS
  We retrospectively analyzed 113 consecutive patients with intertrochanteric fractures treated with PFNA. Fractures were classified in accordance with the AO/OTA classification system into the groups A1, A2 and A3. The postoperative quality of fracture reduction was described as good, acceptable or poor. The location of the blade within the head was recorded as per the Cleveland method. Tip-apex distance (TAD) was used as a method for evaluating screw position. Pre-fracture and postoperative functional level were evaluated by the new mobility score (NMS).
  
  
  RESULTS
  The average age at the time of surgery was 75.9 years. The majority, 75 (66.3 %), were unstable fracture types. The reduction was good in 67 (61.4 %) cases. Of the 24 deaths, 19 patients had comorbidities (p < 0.001). The number of deaths in the first 6 months was significantly higher than in the next 6 months (p = 0.001). The mean TAD was 25.6 mm. The Cleveland zone centre-centre was the most common placement of the blade, accounting for 33 (29 %) of the cases. Reoperation was required in four patients. There were four patients with cut-out. The pre-facture mean value NMS was 8.6 (SD 1.1) and the postoperative mean value was 4.3 (SD 3.6).
  
  
  CONCLUSIONS
  We concluded that PFNA offers biomechanical advantages, but the best position of the blade is still unknown.
authors: Clinic for Orthopaedics and Traumatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Sahmir
authors: S
authors: Sadic
authors: Clinic for Orthopaedics and Traumatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Svemir
authors: S
authors: Custovic
authors: Clinic for Orthopaedics and Traumatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Mahir
authors: M
authors: Jasarevuc
authors: Clinic for Orthopaedics and Traumatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Mirsad
authors: M
authors: Fazlic
authors: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Akademy, Gothenburg, Sweden.
authors: Ferid
authors: F
authors: Krupic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005270:Femur Head / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: PFNA; cut-out; intertrochanteric fractures; mobility