Retrospective evaluation of radiological and clinical outcomes after surgical treatment of proximal femoral fractures utilizing PFNA and PFNA augmented

Friedemann Schneider; Cedric Oettle; Armin Runer; Moritz Wagner; Rohit Arora; Richard A Lindtner

doi:10.1007/s00402-024-05349-8

Retrospective evaluation of radiological and clinical outcomes after surgical treatment of proximal femoral fractures utilizing PFNA and PFNA augmented

Arch Orthop Trauma Surg. 2024 May 3. doi: 10.1007/s00402-024-05349-8. Online ahead of print.

Authors

Friedemann Schneider¹, Cedric Oettle², Armin Runer³, Moritz Wagner⁴, Rohit Arora¹, Richard A Lindtner⁵

Affiliations

¹ Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
² Medical University of Innsbruck, Innsbruck, Austria.
³ Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
⁴ Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Austria.
⁵ Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria. richard.lindtner@i-med.ac.at.

PMID: 38700673
DOI: 10.1007/s00402-024-05349-8

Abstract

Introduction: The primary aim of this study was to evaluate the clinical and radiological outcomes after surgical treatment of proximal femoral fractures utilizing the Proximal Femoral Nail Antirotation (PFNA), with the main focus on complications and reoperations. The secondary aim was to compare the outcomes of patients with and without cement augmentation of the cephalomedullary nails.

Materials and methods: All patients with an acute proximal femoral fracture consequently treated with a PFNA between January 2011 and Dezember 2018 were evaluated. Clinical and radiological data were assessed for intra- and postoperative complications, including treatment failure. In addition, intra- and postoperative radiographs were used to determine the position of the implant, and any migration, via Tip-Apex-Distance (TAD) and the caput-collum-diaphyseal angle (CCD). The accuracy of the fracture reduction was rated according to Baumgaertners criteria.

Results: Two hundred sixty-four consecutive patients (mean age 78.8 ± 12.0; 73.1% female) were included. The predominant OTA/AO fracture classification was 31A1 (153 cases, 58.0%). The average duration of surgery was 63.1 ± 28.0 min and showed no significant differences between PFNA and PFNA with augmentation. The implant positioning was rated as good in 222 cases (84.1%). Two hundred sixty-three patients (99.6%) showed evidence of healing within the time frame of three months postoperatively, one case of delayed union healed after secondary dynamization. During the observational period, 18 patients (6.8%) required a total of 23 additional surgeries. Overall, a lower reoperation rate was observed following the use of the augmentation option (2/86 patients (2.3%) vs. 16/178 patients (9.0%), p = 0.04). In particular, there were no cases of cut-out or cut-through among patients who underwent augmentation as part of osteosynthesis.

Conclusions: Overall reoperation rate after surgical treatment of proximal femoral fractures utilizing the Proximal Femoral Nail Antirotation (PFNA) was 6.8%, with 23 additional surgeries performed in 18 patients. The usage of the PFNA with augmentation showed equally good implant positioning, excellent healing rates and fewer postoperative complications compared to the PFNA implant alone with a similar overall duration of surgery.

Keywords: Cement augmentation; Cephalomedullary nail; Femur; Hip fracture; Intertrochanteric fracture; PFNA; Pertrochanteric fracture; Proximal femoral fracture; Proximal femoral nail.