Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients§

G.N. Kiran Kumar1, Gaurav Sharma1, Kavin Khatri2, Kamran Farooque1, Devendra Lakhotia*, 3, Vijay Sharma1, Sanjay Meena1
1 Department of Orthopaedics, AIIMS, New Delhi-110029, India
2 Department of Orthopaedics, GGS Medical College, Faridkot-151203, India
3 Department of Orthopaedics, Institute For Medical Sciences And Research Centre, Jaipur National University, Jagatpura, Jaipur-302017, India

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© Kumar et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedics, Institute For Medical Sciences And Research Centre, Jaipur National University, Jagatpura, Jaipur-302017, India; Tel: +917823089433; E-mail:
§ This Study is Conducted at JPNATC Level 1 Apex Trauma Centre, AIIMS, New Delhi, India



Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures.

Materials and Methods:

We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement.


The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain.


We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications.

Keywords:: Fixation, Harris hip score, intertrochanteric fracture, intra medullary, proximal femoral nail antirotation II, unstable.