Aguado-Maestro, Escudero-Marcos R, Nistal-Rodrguez J, Alonso-Garc?a N, Prez-Bermejo D, Bauelos-Daz A, Cebrin-Rodreguez E, Ramos-Galea R, and Garcia-Alonso M
Introduction: New concepts regarding instability in extra capsular fractures have led to a better understanding of their biomechanical behavior. Location and direction of the fracture line determine rotational instability in typically defined “stable” fractures. We propose a modification of the classical osteosynthesis with endomedular nail.
Material and methods: Fourteen patients met the inclusion criteria (31A1 fractures with a fracture line angled more than 70 degrees) between October 2012 and February 2013. They were all treated with PFNA nail, standard technique modified by adding a 7.3 mm cannulated screw with anti-rotation effect as described by the authors. X-Ray controls were performed after 24 hours, and after 1, 3 and 6 months, evaluating reduction, helical blade position (Cleveland-Bosworth) and tip-apex distance (Baumgaertner). Consolidation, loss of reduction and function were also reviewed.
Results: Reduction quality was good or fair in 91%, founding the helical blade in center-center position in every case, with an average tip-apex distance of 12.24 mm.
Conclusions: The theory of helical blade rotation through the femoral is becoming more and more relevant regarding cut out. Defining those fracture lines affected by rotational instability will lead to more easily determining the criteria for using a cannulated screw for additional stabilization. The technique is safe, simple and easily replicated. Satisfactory results were observed in all the cases, despite the small sample size.
