Methods of measuring location of proximal femoral nail antirotation (PFNA) insertion and prediction of lag screw migration in trochanteric fracture of the hip after PFNA fixation
Keywords:
PFNA, Hip fracture, Failure of FixationAbstract
Hip fracture is an increasingly common problem, especially in the elderly. The most popular type of surgery today is proximal femoral nail antirotation (PFNA). However, there were also frequent complications such as screw migration, screw cut-out and non-union. The objective of this study was to study the ability to predict lag screw migration of the method for measuring the position of PFNA insertion with TAD, Cal-TAD, Parker AP, Parker Lat and TFD.
Quantitative research retrospective cohort study from the electronic X-ray database of Sansai Hospital. In all patients with trochanteric region hip fracture over 60 years of age who received surgical PFNA treatment from June 1, 2019 to May 31, 2020, X-ray images were assessed after surgery on the day of surgery or after 1 day of surgery and during 3 to 6 months. TAD, Cal-TAD, Parker AP, Parker Lat, TFD and Tip of lag screw were measured.
From 83 patients included to this study, 59 patients were able to measure the values completely, 61% were female, 63% right hip fracture, most of them were aged 80-90 years (28 patients, 40.7%). The mean of screw migration was 12.23 (SD 7.78) mm. The results showed that TAD, Cal-TAD and TFD were associated with screw migration, coefficience = 1.2319, 1.4799 and 1.2720 respectively (p < 0.001). Parker AP and Parker Lat found no correlation for Coef. 0.0009 and -0.8365 (p > 0.05).
Measuring the position of PFNA insertion by TAD, Cal-TAD and TFD was able to predict lag screw migration significantly. Minimal value Predict the least lag screw migration or position the tip of lag screw as close to the center of fovea capitis as possible.
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