Helical blade compression failure occurred during PFNA implantation: A rare case and ingenious solution

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomedical engineering

Background:

• Femoral intertrochanteric fractures are common in the elderly, particularly those with osteoporosis.
• Proximal Femoral Nail Anti-rotation (PFNA) is a standard intramedullary implant for these fractures.
• While postoperative failures are reported, intraoperative blade tightening issues are less documented.

Observation:

• An 81-year-old female patient presented with a comminuted left intratrochanteric fracture (Jensen IIa).
• During PFNA implantation, the helical blade could not be tightened using the standard blade impactor.
• This presented an unprecedented intraoperative complication.

Findings:

• A novel technique was employed using a cannulated hexagonal screwdriver to successfully tighten the helical blade.
• This intervention resolved the intraoperative blade compression failure.
• The surgical procedure was completed successfully without adverse events.

Implications:

• The cannulated hexagonal screwdriver provides an effective solution for intraoperative PFNA helical blade tightening failures.
• This technique can prevent surgical delays and potential complications associated with blade removal and reinsertion.
• It highlights the importance of adaptable surgical techniques and readily available instrumentation in managing unexpected orthopedic challenges.