Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis
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Presently, unstable intertrochanteric femur fractures are treated commonly with intramedullary nailing devices. Various designs of intramedullary nail are introduced. The conventional Proximal Femoral Nail has given diverse outcome. Complications have also been noted with this implant. Newer designs like Proximal Femoral Nail Antirotation-2 have been introduced for Asian population. The aim of our study was to compare the radiological and functional outcome of unstable intertrochanteric femur fracture treated with conventional Proximal Femoral Nail and Proximal Femoral Nail Antirotation-2 in osteoporotic patients.
Materials and methods
Patients presenting with unstable intertrochanteric femur fracture (AO classification) and Singh’s index ≤ 3 were included. Patients were assigned to the groups based on the implant used for treatment (PFN and PFNA2 group). Post-operative radiographs were used to assess the quality of reduction, by calculating neck shaft angle. The quality of fixation was assessed, by calculating tip apex distance and Cleveland index. The duration of surgery, blood loss, number of fluoroscopic images taken and length of hospital stay were noted. Patients were followed up for 6 months, and complications were noted. The functional outcome was compared using modified Harris hip score. The data analysis was done using Student’s unpaired t test/Mann–Whitney U test and Chi-square test/Fisher’s exact test. A p value less than 0.05 was considered significant.
Seventy-eight patients with unstable intertrochanteric fractures and Singh’s index < 3 were included. Thirty-seven were treated with PFNA2 and 41 with PFN. The average age in PFNA2 group was 69.51, and PFN group was 70.804. Nine patients in PFNA2 group and 10 patients in PFN group had tip apex distance more than 25 mm. Twelve patients in PFNA2 group and 14 Patients in PFN group had sub-optimal implant position as per Cleveland index. The difference in neck shaft angle between uninjured and operated side was more than 10° in four patients of PFNA2 group and seven patients of PFN group. The average Harris hip score was 74.55 for PFNA2 group and 69.88 for PFN group. Four complications were seen in PFNA2 group and 5 in PFN group.
The functional outcome (p = 0.102) achieved with both the implants was similar. Good functional outcome can be achieved, when the radiological parameters are restored, i.e. TAD < 25 mm, Cleveland index in centre–centre position and neck shaft angle difference < 5°. The overall complications, in the set-up of osteoporosis, seen with both the implants were similar (p = 0.44). PFNA2 group showed better results in terms of perioperative morbidity.
KeywordsIntramedullary nailing Singh’s index Neck shaft angle Tip apex distance Cleveland index
We are grateful for the help and support from KMC Mangalore and Manipal Academy of Higher Education in performing this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 2.Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y et al (2014) Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta- analysis. Med Sci Monit 20(1628–33):3Google Scholar
- 3.Dhamangaonkar AC (2015) Management options and treatment algorithm in intertrochanteric fractures. Trauma Int 1(1):12–16Google Scholar
- 5.Hohendorff B, Meyer P, Menezes D, Meier L, Elke R (2005) Treatment results and complications after PFN osteosynthesis. Unfallchirurg. 108(11):938, 940, 941–946 passimGoogle Scholar
- 7.Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N (2006) Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures. Biomech Eval Inj 37:984–989Google Scholar
- 10.Sharma A, Mahajan A, John B (2017) A comparison of the clinico-radiological outcomes with proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) in fixation of unstable intertrochanteric fractures. J Clin Diagn Res 11(7):RC05–RC09Google Scholar
- 19.Sadic S, Custovic S, Jasarevic M, Fazlic M, Smajic N (2014) Proximal femoral nail antirotation in treatment of fractures of proximal femur. Med Arch 68:172–177Google Scholar
- 21.Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M et al (2008) Treatment of trochanteric fractures with the proximal femoral nail antirotation (PFNA) nail system—report of early result. Bull NYU Hosp Jt Dis 66(4):276–279Google Scholar
- 23.Li J, Cheng L, Jing J (2015) The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients. Orthop Traumatol Surg Res 101(2):143–146. https://doi.org/10.1016/j.otsr.2014.12.011 CrossRefGoogle Scholar
- 24.Xie H, Chen S, Zhou B (2015) Comparison of proximal femoral nail antirotation-II and proximal femoral nail antirotation in fixation of femoral intertrochanteric fracture. Zhonghua Yi Xue Za Zhi 95(29):2346–2350Google Scholar