股骨近端带锁髓内钉联合抗骨质疏松药物治疗高龄不稳定型股骨粗隆间骨折的疗效观察

目的：采用股骨近端带锁髓内钉（ PFN）微创内固定术结合规范抗骨质疏松方案治疗高龄不稳定型股骨粗隆间骨折,评估近期疗效。方法2010年1月至2012年12月,对92例不稳定型股骨粗隆间骨折行微创内固定术治疗,其中男32例,女60例,年龄70～88岁,平均年龄78．5岁。骨折采用Tronzo-Evans分型,其中Ⅲ型46例,Ⅳ型34例,Ⅴ型12例。术前骨密度测量值（ DEXA法）为0.46～0.82 g/cm2,平均0.64±0.16 g/cm^2,均达到严重骨质疏松的诊断标准。固定方式采用股骨近端带锁髓内钉（ PFN）,骨缺损严重者予Wright人工骨粒植入。术后早期床上进行双下肢肌肉锻炼,CPM机辅助治疗。先后给予鲑鱼降钙素、唑来膦酸并补充钙剂、维生素D进行抗骨质疏松治疗。结果所有患者均顺利完成手术,术后无伤口感染等并发症;根据Parker髋关节功能评分,优62例,良22例,一般6例,差2例,优良率91.3％。所有患者均获得12个月以上连续随访,经X线片证实均达到骨性愈合。骨折愈合时间12～18周,平均14.5周,3例患者发生旋转螺钉向后轻度退出。结论 PFN结合抗骨质疏松治疗高龄不稳定型股骨粗隆间骨折,具有创伤小、固定可靠,利于骨折愈合等优点,近期疗效满意。     

Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty

A prospective, comparative study was done over a period of 3 years to compare the complications and functional results of two treatment modalities of unstable intertrochanteric fractures of the femur in the elderly; i.e closed reduction and internal fixation (CRIF) with proximal femur nail (PFN) and primary cemented hemireplacement arthroplasty (HRA) with bipolar prosthesis. 100 elderly patients with unstable intertrochanteric fractures of femur were studied over a period of 3 years. 50 patients underwent CRIF with PFN and 50 patients were treated with primary cemented hemireplacement arthroplasty with bipolar prosthesis. Harris Hip score analysis revealed that the difference between the patients treated with cemented hemiarthroplasty and proximal femoral nailing was statistically significant in favour of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point and reversed at the 12 month time point indicating a better functional outcome of Proximal Femur Nail in the long term. Although cemented hemireplacement arthhroplasty allows early pain free mobilization and has a good short term outcome, over time it is associated with a variety of complications which significantly affects quality of life of patients. On the other hand, although patients treated with PFN had delayed post op mobilization, they had better results when followed up at 1 year post surgery.     

Clinical outcome of conventional versus biological fixation of subtrochanteric fractures by proximal femoral locked plate

IntroductionSurgical fixation is the standard management of the subtrochanteric fractures. Proximal femoral locked plating (PF-LCP) provides a strong construct for fixation with a high success rate. However, some studies reported implant failure due to loss of the postero-medial bone support and recommended an anatomical reduction. Other studies reported excellent to good results with indirect (biological) fixation without anatomical reduction. In this study, we reviewed the short-term clinical results of PF-LCP fixation for subtrochanteric fractures using both conventional and biological fixation.Materials and methodsForty six patients (34 males and 12 females) with comminuted subtrochanteric fractures were included aged between 18 and 74 (mean 44.3 years). They were treated in a single-blind random manner by either conventional (open, direct) or biological (indirect) reduction method and internal fixation with PF-LCP. Intra-operative variables including; duration of surgery, blood loss, fluoroscopy time and any complications were recorded. Post-operative differences including; duration of healing, implant failure, complications and the final clinical outcome by Harris Hip Score (HHS) were documented.Results44 cases continued to the final follow-up (23 of the open fixation group and 21 of the biological fixation group). Patients of open group demonstrated greater blood loss (756 ± 151 vs. 260 ± 39 ml; P < 0.0001), longer operative times (129 ± 16.9 vs. 91 ± 8 min; P < 0.0001) and incisions (s) length (20.4 ± 3 vs. 13.4 ± 1 cm; P < 0.0001). More patients needed blood transfusion in open group (11 patients vs. six in closed group; P < 0.0001). Patients of biological group demonstrated longer fluoroscopy time (80.9 ± 7.3 vs. 47.2 ± 5.8 sec.; P < 0.0001). For each group, one case of implant failure was recorded. Low patient compliance was a detrimental factor for the implant failure in both cases. No much difference was demonstrated for the healing rate (open group; 18.3 ± 3.7 vs. biological group16.5 ± 4 weeks; P < 0.058) and for the functional outcome (open group; excellent/good: 54%/37%, biological group; excellent/good: 57%/33%; P = 0.766).ConclusionPF-LCP provided a strong construct for fixation of the comminuted subtrochanteric fractures either by open or biological techniques. Low patient compliance is an influential factor for implant failure in both types.     

股骨近端锁定钢板与Gamma 3型髓内钉固定不稳定股骨粗隆间骨折的生物力学研究

目的比较股骨近端锁定钢板与Gamma 3型髓内钉在固定不稳定股骨粗隆间骨折中的生物力学特性,为临床选择内固定方式提供理论依据。方法选取5对防腐股骨标本,每对标本配对随机分为A组和B组,所有股骨标本制成31-A2.2型骨折模型,A组使用Gamma 3型髓内钉固定,B组使用股骨近端锁定钢板固定,在力学测试机上进行轴向压缩、扭转、破坏试验。结果在1 200 N载荷时,A组轴向刚度为(306.52±11.32)N/mm,B组为(258.38±14.63)N/mm,A组的轴向刚度较B组高18.6%,差异有统计学意义(t=17.74,P=0.03)。A、B组在扭转角为0.5°、1.0°、1.5°、2.0°、2.5°时的扭矩值差异均无统计学意义(P0.05)。A组扭转刚度为(1.35±0.06)N·mm/deg,B组为(1.48±0.09)N·mm/deg,2组差异无统计学意义(t=-5.00,P=0.13)。A组最大屈服载荷为(3 101.33±174.83)N,B组最大屈服载荷为(2 396.68±142.07)N,A组最大屈服载荷值较B组高29.4%,差异有统计学意义(t=48.52,P0.001)。结论股骨近端锁定钢板在内固定治疗以31-A2.2型骨折为例的不稳定股骨粗隆间骨折时,其轴向负重力学性能不如Gamma 3型髓内钉,不宜作为首选内固定。     

Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.     

股骨近端锁定接骨板治疗特殊类型股骨近端骨折

背景：应用髓内固定系统规范化治疗股骨近端骨折已得到临床上的广泛共识,但是对于某些特殊类型的股骨近端骨折如股骨转子下骨折、股骨近端外侧壁不完整等的治疗仍较困难。目的：探讨股骨近端锁定接骨板（LPFP）治疗特殊类型股骨近端骨折的疗效。方法：2012年5月至2014年5月应用LPFP治疗特殊类型股骨近端骨折22例,其中股骨转子间骨折伴股骨近端外侧壁不完整9例（Evans-Jensen分型：Ⅲ型5例,Ⅴ型4例）;股骨转子下骨折10例（Seinsheimer分型：ⅡA型2例,ⅡB型2例,ⅢB型4例,Ⅴ型2例）;股骨颈骨折伴股骨转子下骨折2例,股骨转子间骨折伴股骨上段骨折1例。所有患者均采用LPFP内固定术,记录手术时间、术中出血量、术后并发症、骨折愈合时间和术后髋关节功能评分。采用Harris评分评估髋关节功能情况。结果：手术时间为65~150 min,平均96 min;出血量为80~750 ml,平均360 ml。22例全部获得随访,随访时间为3~27个月,平均12.8个月。1例患者在术后4个月发生锁钉断裂,2例发生延迟愈合,无一例出现切口感染和深静脉血栓。骨折愈合时间为2~20个月,平均3.2个月。髋关节Harris评分为78~99分,平均86分。结论：LPFP治疗股骨转子下骨折、股骨近端外侧壁不完整等特殊类型股骨近端骨折,具有创伤小、安全性高等特点,是髓内固定治疗股骨近端骨折的有益补充。     

The outcome of unstable proximal femoral fracture treated with reverse LISS plates

BackgroundThe Russel-Taylor type 2B fractures compromised the trochanteric region and medial buttress of proximal femur. This fracture pattern limits the choice of implants and raises the risk of adverse outcomes. We aimed to (i) determine the outcome of Russel-Taylor type 2B fractures treated using reverse less invasive stabilization system plates (LISS-DF) and to (ii) learn what factors affected outcomes after osteosynthesis with reverse LISS plates.DesignA retrospective studySettingThe study was conducted at a Level III trauma center in Taiwan.MethodsTwenty-five consecutive patients presenting with a Russel-Taylor type 2B fracture were enrolled. All cases were treated with reverse LISS plates. A Modified Radiographic Union Scale for Femur (RUSF), Radiographic parameters, functional scores, and complications were assessed.ResultsUnion occurred in 21 cases at an average of 18.8 weeks. The average immediate postoperative neck-shaft angle was 130° (range: 122–135°) compared with 139° (range: 135–141°, p = 0.05) on the contralateral side. Two cases had complications of proximal screws cutting out and two cases had broken implants. Finally, all 4 cases required repeated surgeries (16%). Malunion occurred in 4 patients and early mechanical failure (proximal screws cut out) occurred in 2. There was a significant difference in the purchase index of the proximal screws between cases with redisplacement and those without (26.4 mm and 98.6 mm, p = 0.01).ConclusionsThe use of reverse LISS plate appeared to be an alternative procedure for the specific pattern in the present study. We recommend using this reverse locking plate to treat unstable proximal femoral fractures with meticulous techniques of placing plates. Adequate purchase of the proximal locking screws might decrease the risks of complications.     

PFLCP内固定治疗老年外侧壁危险型股骨粗隆间骨折的疗效观察

目的评价股骨近端锁定加压钢板(PFLCP)内固定治疗老年外侧壁危险型股骨粗隆间骨折的临床疗效。方法回顾性分析自2009-06—2013-10采用PFLCP内固定治疗72例老年外侧壁危险型股骨粗隆间骨折,术后依据Harris评分评价患者髋关节功能恢复情况。结果所有患者均获得随访12~22个月,平均14.3个月。骨折均愈合,愈合时间13~21周,平均17.1周。术后1年疗效依据Harris评分评定:优54例,良10例,可3例,差5例,优良率88.9%。出现髋内翻畸形2例,髋外展无力1例,大粗隆顶端骨块上移1例。无股骨头切割、内固定断裂及骨折不愈合等并发症发生。结论PFLCP治疗老年外侧壁危险型股骨粗隆间骨折符合生物力学特性,骨折愈合率高,功能恢复佳,并发症少,是治疗此类骨折安全有效的方法。     

应用肱骨近端锁定钢板治疗肱骨近端骨折

目的观察、评价肱骨近端锁定钢板（LPHP）治疗肱骨近端骨折的疗效。方法通过分析自2008—01—2012—10收治并随访的52例肱骨近端二部分以上骨折。采用有限切开、透视复位、肱骨近端锁定钢板内固定的方法治疗,骨缺损患者采用自体髂骨及人工骨植骨。结果本组获得随访8—25个月（平均15个月）,肱骨近端骨折均得到了愈合,按Neer肩关节功能评分标准：优25例,良18例,可6例,差3例,优良率82．7％。未发生断板、断钉,无肱骨头缺血坏死及肩峰撞击综合征。结论应用肱骨近端锁定钢板治疗肱骨近端骨折,骨缺损者取髂骨、人工骨植骨,根据骨折类型及稳定性等指导功能锻炼,骨折愈合良好、并发症少、关节功能恢复好。     

股骨近端锁定钢板治疗不稳定股骨转子间骨折

目的探讨股骨近端锁定钢板治疗不稳定股骨转子间骨折的临床疗效。方法对27例不稳定型股骨转子间骨折患者采用股骨近端锁定钢板内固定。结果 27例均获随访,时间4~18个月。1例出现髋内翻畸形。26例均获骨性愈合,愈合时间4~7个月。末次随访时髋关节功能按Harris评分标准评定:优14例,良9例,可3例,差1例。结论股骨近端锁定钢板内固定治疗不稳定股骨转子间骨折具有创伤小、并发症少、内固定可靠、骨折愈合率高等优点,适用于不稳定型股骨转子间骨折,特别是伴有骨质疏松症患者。     

改良股骨近端锁定钢板治疗骨质疏松性股骨转子间骨折的临床观察

目的 :探讨股骨近端锁定钢板(PFP)治疗股骨转子间骨折的疗效与失败病例的分析。方法 :2013年1月至2014年3月,采用施乐辉股骨近端锁定钢板治疗骨质疏松性EvansⅠ、Ⅱ型股骨转子间骨折32例,其中男17例,女15例;年龄70~86岁,平均77.3岁;采用Harris髋关节功能评分标准评价其疗效结果。结果:所观察32例患者的手术时间为(60.5±15.7)min,术中失血量(128.8±73.6)ml,患者围手术期输血量为(224.0±72.7)ml,住院时间14~20 d,平均17.2 d。出院后32例获随访,随访时间6~18个月,平均14.1个月。32例骨折全部愈合,愈合时间为3~6个月,平均3.1个月。1例出现内固定松动及退钉,4例出现尿路感染,1例术后6个月死于心血管疾病,2例术后1年死于脑卒中,未出现切口深部感染、内固定周围骨折、下肢深静脉血栓、内固定断裂、骨折不愈合、严重髋内外翻等。Harris功能评分平均为89.74±6.84;结果优10例,良16例,中4例,差2例。结论:股骨近端锁定钢板可予骨质疏松性股骨骨折的近端提供较稳定的固定把持,是治疗股骨转子间骨折的一种选择,可稳定骨折断端,保证骨折愈合。     

A biomechanical study comparing proximal femur nail and proximal femur locking compression plate in fixation of reverse oblique proximal femur fractures

BackgroundThe reverse oblique trochanteric fractures are common fractures and its treatment poses a challenge. The purpose of this study was to compare the biomechanical parameters of the construct using proximal femoral nail (PFN) and proximal femoral locking compression plates (PFLCP) in these fractures using cadaveric specimens.Materials and MethodsTwenty freshly harvested cadaveric femoral specimens were randomly assigned to two groups after measuring bone mineral density, ten of which were implanted with PFN and the other ten with PFLCP. The constructs were made unstable to simulate reverse oblique trochanteric fracture (AO type 31A3.3) by removing a standard size posteromedial wedge. These constructs were tested in a computer controlled cyclic compressive loading with 200 kg at a frequency of 1 cycle/s (1 Hz) and test was observed for 50,000 cycles or until implant failure, whichever occurred earlier. Peak displacements were measured and analysis was done to determine axial stiffness and subsidence in axial loading.ResultsAll the specimens in PFN group completed 50,000 cycles and in PFLCP group, seven specimens completed 50,000 cycles. Average subsidence in PFN group was 1.24 ± 0.22 mm and in PFLCP group was 1.48 ± 0.38 mm. The average stiffness of PFN group (72.6 ± 6.8 N/mm) was significantly higher than of PFLCP group (62.4 ± 4.9 N/mm) (P = 0.04). The average number of cycles sustained by PFLCP was 46634 and for PFN group was 50,000 (P = 0.06).ConclusionThe PFN is biomechanically superior to PFLCP in terms of axial stiffness, subsidence and number of specimens failed for the fixation of reverse oblique trochanteric fractures of femur.     

肱骨近端锁定钢板与传统AO钢板治疗老年肱骨近端骨折的比较

目的比较肱骨近端锁定钢板与传统AO钢板治疗老年肱骨近端骨折的疗效。方法2002年7月-2005年5月间收治37例老年肱骨近端骨折患者,采用肱骨近端锁定钢板(LPPH)治疗18例,年龄65-82岁(平均69岁),Neer分型三部分骨折12例,四部分骨折6例;采用传统AO钢板治疗19例,年龄65-84岁(平均71岁),Neer分型三部分骨折12例,四部分骨折7例。术后肩关节功能评估采用肩关节疼痛和功能障碍指数(SPADI)量表评分,对两组疗效进行比较。结果术后6周、12周、1年随访肩关节功能、骨折愈合及肱骨头坏死情况,发现LPPH治疗组的钢板螺丝钉松动发生率、术后肩关节评分均优于传统AO钢板治疗组。结论LPPH治疗老年骨质疏松患者的肱骨近端骨折相比传统AO钢板有明显的优势。     

Epidemiology of fractures of the proximal femur in Geneva: Incidence,clinical and social aspects

Fracture of the proximal femur (hip fracture) as a consequence of osteoporosis is an important public health problem. Its incidence, which rises with age, varies according to geographical location and race. There is no information concerning hip fracture in Switzerland, which is a Western country with a particularly aged population. During 1987, 361 patients with hip fracture were recorded in the University of Geneva Hospital, which is the main referral center for a population of about 376000 inhabitants. This represented 94% of all hip fractures occurring in the region. A moderate trauma was reported in 329 cases (91.1%). The overall annual incidence was 96.1 per 100000 population (146.9 for women and 39.8 for men). When only hip fractures following moderate trauma were considered, the incidence was 87.6 per 100000 population (138.8 for women and 30.8 for men). Rare under the age of 65, hip fracture incidence increased exponentially in older subjects. The mean age of patients with hip fracture was 82.0 years in women and 75.7 years in men. The ratio of cervical to trochanteric fracture was 1.03 and 1.12 in women and men, respectively. The mean length of stay in the orthopaedic ward was 30.5 days, and the total costs amounted to 8.8 million Swiss francs for hip fracture associated with moderate trauma. Forty-seven percent of subjects were transferred to another hospital for recovery or rehabilitation. During the stay in the orthopaedic ward, the mortality rate was 8.2%. These results emphasize the high incidence and cost of hip fractures in a region of Switzerland where the population is particularly old. The problem could even worsen with the progressive aging of the population.     

Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis

Background  Different operative techniques used for treating displaced proximal humeral fractures could result in malunion, non-union, osteonecrosis of humeral head, loosening of screw and loss of reduction particularly in comminuted and osteoporotic fractures. Locking compression plate (LPHP) has been proposed for open reduction and internal fixation of these fractures and is associated with less complication rate. Materials and methods  We prospectively assessed the functional outcome and the complications after an average follow-up of 24.9 months in 25 patients of proximal humeral fractures with osteoporosis. Mean age was 62 years. Using AO classification, 48% were type A and 52% type B. Results  Mean constant score was 80 points. According to constant score, 28% had excellent outcome, 64% had good functional outcome, and 8% had moderate outcome. When the results were related to grades of osteoporosis, grade IV osteoporotic fractures had highest average Constant–Murley score (83 points, range 78–88 points), followed by grade III osteoporotic fractures (80 points, range 71–92 points), followed by grade II osteoporotic fractures (78 points, range 66–88 points). Varus malalignment and subacromial impingement were observed in 8% patients. Loosening of implant and loss of reduction were observed in 4% patients. Superficial infection was observed in 4% patients. Conclusions  Locking compression plate (LPHP) is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization.     

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate

Objectives

We report early results using a second generation locking plate, non-contact bridging plate (NCB PH^®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH^® combines conventional plating technique with polyaxial screw placement and angular stability.

Design

Prospective case series.

Setting

A single level-1 trauma center.

Patients

A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005.

Intervention

Surgery was performed in open technique in all cases.

Main outcome measures

Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant–Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks.

Results

All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76.

Conclusions

The NCB PH^® combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH^® is a safe implant for the treatment of proximal humeral fractures.

     

Cannulated interlocking titanium prosthesis in pathological proximal femoral fractures: a prospective study

The surgical management of metastatic lesions of proximal femur poses a challenge to the surgeon. Internal fixation procedures may not be feasible due to the location and size of the lesion and long stem endoprosthetic replacement may be a safer and preferred option. Bone cement though ideal may not be desirable in high risk patients. Un-cemented cannulated intramedullary prosthesis combines the principles of hemiarthroplasty and an interlocking intramedullary fixation. The prosthesis was used in 10 consecutive patients with 10 completed and 2 impending fractures of proximal femur with a disease free acetabulum. Surgical revision was considered the end point of the study. Pain free, full weight bearing mobilisation was possible in eight patients and no patient required revision until their death. The prosthesis provided a satisfactory solution with minimum surgical complications in high risk patients in our study.     

Mid term results of PlantTan plate in the treatment of proximal humerus fractures

This prospective study evaluates the clinical efficacy of a special implant, PlantTan plate used for fixation of displaced proximal humerus fractures. The PlantTan plate was used for internal fixation of closed displaced proximal humeral fractures in 68 patients from September 1999 to June 2002, in a University Hospital. One of the surgeries was for a non-union, and five patients were lost to follow-up. The patients' ages ranged from 19 to 76 years (mean 61 years and median 66 years). Of the remaining 62 patients, 42 were female and 20 were male. As defined using the Neer classification 19 patients had two part, 37 three part and 6 had four part fractures. Median follow-up was 19 months (11-38). The outcome was assessed using radiographs, American Shoulder and Elbow Surgeons (ASES) score and Hospital for Special Surgery (HSS) scoring system. Fifty-two patients achieved union in a median of 8 weeks. The median cumulative score of activities of daily living of ASES was 20.4/30 (13-27). According to HSS, 11 scored excellent, 26 good, 14 fair and 11 scored poor. Eight patients had fixation failure and two developed avascular necrosis. Eleven patients developed an infection. Six patients developed an infection resulting in implant removal. One had a transient and one permanent axillary nerve palsy. Since the PlantTan plate provides stability, early active rehabilitation can be instituted. The implant is distally placed reducing impingement symptoms. However, the implant requires wide surgical exposure, is bulky and has an unacceptable infection rate. The fixation failure is high in patients with osteoporosis. In view of the above encountered problems, the implant has been discontinued in our hospital.     

A computed tomography-based analysis of proximal femoral geometry for lateral impingement with two types of proximal femoral nail anterotation in subtrochanteric fractures

Objective

To evaluate and analyse the geometrical discrepancies between the proximal femur and two types of AO/Association for the Study of Internal Fixation (AO/ASIF) Proximal Femoral Nail Anterotation (PFNA/PFNA-II) using computed tomography (CT)-based analysis in Asian patients, and its implication in lateral cortical impingement during reduction intra-operatively in subtrochanteric fractures.

Materials and methods

Coronal CT images of hips in 50 randomly selected healthy cases were analysed using a unique measurement method with respect to the height, diameter, bending angle and inclination angle of lateral cortex of proximal femur. The data were then compared with dimensions of PFNA and PFNA-II.

Results

The average height of proximal femur was 61.1 ± 5.2 mm, diameter 18.1 ± 1.5 mm, bending angle 8.4 ± 2.2° and inclination angle of lateral cortex 11.9 ± 1.1°. The average impingement length of the lateral cortex was 54.2 ± 4.7 mm (range 41.4-64.2 mm), which was shorter than the height of the proximal femur. On comparison with dimensions of PFNA and PFNA-II, the lateral inclination angle and impingement length were found to be discrepant in PFNA; however, in the latter the flat lateral surface helps avoiding impingement with the lateral femoral cortex.

Conclusion

Our study provides clear evidence that the flat lateral shape of PFNA-II is better suited for the femur of Asian patients by reducing the chances of impingement with the lateral proximal femoral cortex during intra-operative reduction in subtrochanteric fractures.