Proximal Femur Nail Antirotation-II: Complication of Protrusion of Proximal End of Nail Over Greater Trochanter in Indian Population.

BACKGROUND

Intramedullary nails are increasingly being used for intertrochanteric fractures. PFNA-II has shown good outcomes; however, some characteristic complications are also reported due to mismatch between implant design and anatomy of the proximal femur in the Asian population. Our paper aims to study outcomes and complications of PFNA-II in a North Indian population.

MATERIAL AND

METHODS

This single centre study was conducted at a teaching hospital in North India. 116 patients were recruited, of which 105 were included in the final analysis. The protrusion height of the nail tip in the early postoperative radiograph was used to divide the cohort into two groups: group A with nail protrusion and group B without nail protrusion. Clinical and radiographic outcomes were measured and compared between the two groups.

RESULTS

Nail protrusion was seen in 62% cases (Group A) while 38% did not have any nail protrusion over GT (Group B). Average protrusion in Group A was 12.6 mm. The average protrusion differed between males and females with doubtful statistical significance (6.7 versus 8.3, p=0.0537). At one-year follow-up, 40% experienced GT pain (52% in Group A and 20% in Group B) (p<0.0021). Harris hip score was 78.6 and did not differ significantly between the groups.

CONCLUSION

PFNA-II is an excellent implant for intertrochanteric fractures. However, implant-bone mismatch in some populations can lead to proximal nail protrusion, causing proximal thigh pain. We advocate modifying PFNA-II, shortening proximal nail end by 5-10 mm and introducing end-caps of varying heights for better adaptation, particularly in Indian/Asian populations.