Cause analysis and clinical management of postoperative complications of proximal femoral nail anti-rotation in treating intertrochanteric fractures

Objective To investigate the causes and managements of postoperative complications of proximal femoral nail anti-rotation(PFNA)in treating intertrochanteric fractures. Methods A total of 155 patients with intertrochanteric fractures were treated with PFNA from January 2011 to December 2017.Causes and managements of postoperative complications were analyzed and discussed. Results At an average follow-up of 48 months(range, 12~72 months), the rate of good postoperative recovery in hip function was 96.0%.Among 155 patients, the internal fixation-associated postoperative complications occurred in 15(9.7%)patients.Details were as follows: 7 cases had spiral blade breakage into the femoral head or inwardly, in whom 5 cases received artificial joint replacement whereafter.5 cases had coxa vara, mainly in patients with obvious posterior fracture of the femoral intertrochanter with obviously bone fragments.3 cases had delayed fracture healing due to the fracture damaging calcar femorale, or extensive soft tissue dissection during the operation on small trochanter.The Harris function score was 82 points. Conclusions The location of the PFNA spiral blade, as an important factor, is correlated with postoperative complications, while severe osteoporosis, unstable fractures, and poor fracture reduction increase the incidence of surgical complications.