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Klinische Evaluation des PFNA® und Zusammenhang zwischen Tip-Apex-Distanz und mechanischem Versagen

Clinical evaluation of PFNA® and relationship between the tip-apex distance and mechanical failure

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Zusammenfassung

Die Inzidenz per- und subtrochantärer Frakturen nimmt in Deutschland zu, die Folgekosten und die Mortalität sind hoch. Ziel der Studie war die retrospektive Evaluation des PFNA® („proximal femoral nail antirotation“) hinsichtlich klinischer Anwendbarkeit und mechanischer Komplikationen.

In einer retrospektiven Analyse wurden alle Patienten mit pertrochantärer und subtrochantärer Femurfraktur, die zwischen 12/2004 und 12/2007 mit einem PFNA® versorgt wurden, eingeschlossen und nach klinischen und radiologischen Gesichtspunkten ausgewertet. In die Studie eingeschlossen wurden 195 Patienten; 61,2% der Patienten wurden Singh I und II klassifiziert. Die durchschnittliche Operationsdauer betrug 57 min. In 10 Fällen (5,1%) kam es zur Klingendislokation, in 4 Fällen (2,1%) zum Cut-out, in 1 Fall kam es zum Nagelbruch (0,5%). Der mittlere TAD insgesamt betrug 26,7 mm, bei Cut-out 41,3 mm und bei Klingendislokationen 38,6 mm. Bei einem TAD<30 mm kam es zu keinem Versagen. Es besteht ein hochsignifikanter Zusammenhang zwischen mechanischem Versagen und Tip-Apex-Abstand (TAD; p<0,001). Das Follow-up lag bei 84,6% nach durchschnittlich 36 Monaten, 30,2% der Patienten verstarben im Nachbeobachtungszeitraum.

Der PFNA® ist ein sicher anzuwendendes System zur Versorgung per- und subtrochantärer Femurfrakturen, der TAD spielt beim Auftreten mechanischer Komplikationen die entscheidende Rolle.

Abstract

The incidence of trochanteric fractures is increasing in Europe, and the economic impact and mortality is high. The aim of the study was to evaluate the PFNA® (proximal femoral nail antirotation) with respect to its clinical use and mechanical complications.

All patients with a trochanteric fracture who had been treated with a PFNA® between 12/2004 and 12/2007 were identified and analysed regarding complications and radiological findings. The study included 195 patients; 61.2% of the patients were classified as Singh I und II. The mean duration of surgery was 57 min. In ten cases (5.1%) the blade migrated, four cases (2.1%) showed blade cut out and in one case the nail broke (0.5%). The mean TAD was 26.7 mm, in cases of cut out 41.3 mm and in blade migrations 38.6 mm. No failure could be documented when the TAD was less then 30 mm. There is a strong relationship between increasing TAD and mechanical failure (P<0.001); 84.6% of the patients have been followed up, and 30.2% died in the follow-up period.

The PFNA® is an easy-to-use implant for the treatment of stable and instable proximal femur fractures. Mechanical failure depends on the TAD.

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  1. Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Zentrum für Chirurgie, Universitätsklinik Ulm, Steinhövelstraße 9, 89075, Ulm, Deutschland

    M. Kraus, G. Krischak, K. Wiedmann, C. Riepl,  F. Gebhard, J.A. Jöckel & A. Scola

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  1. M. Kraus
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  2. G. Krischak
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  3. K. Wiedmann
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  4. C. Riepl
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  5. F. Gebhard
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  6. J.A. Jöckel
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  7. A. Scola
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Correspondence to F. Gebhard.

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Kraus, M., Krischak, G., Wiedmann, K. et al. Klinische Evaluation des PFNA® und Zusammenhang zwischen Tip-Apex-Distanz und mechanischem Versagen. Unfallchirurg 114, 470–478 (2011). https://doi.org/10.1007/s00113-011-1975-0

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