Early Functional Outcome of Osteoporotic Intertrochantric Fractures in Elderly Managed with Proximal Femoral Nail and Proximal Femoral Nail Antirotation: A Comparative Study

Abstract

Introduction: The choice of an implant in the management of intertrochanteric fractures of the femur has evolved from extramedullary devices to intramedullary ones. The proximal femoral nail antirotation (PFNA) that employs a helical blade is a recent and promising advancement but there is a paucity of data in the literature to prove its superiority over its predecessor nails in terms of functional gains. Aim: To compare the functional outcome of PFNA with proximal femoral nail (PFN). Materials and Methods: In this prospective randomized control study in osteoporotic elderly patients, 32 patients managed with PFNA were compared with a similar number treated with PFN and compared in terms of demography, intraoperative variables (duration of surgery, fluoroscopy time, and blood loss), time to union, and functional outcome utilizing Harris hip scores (HHS) at 6 and 12 months follow-up. Results: Both the groups were comparable in terms of age, gender, type of fracture, and Singh’s osteoporosis index. Although the duration of surgery and fluoroscopy time was significantly less in the PFNA group, it did not translate into any functional gains to the patients as the time to union and the HHS, at 6 and 12 months did not reveal any significant difference. Implant-related complications were significantly more in the PFN group with five patients having varus collapse, one having screw cut-out, two having screw pull-out, and one having Z-effect. Conclusion: Although there was no significant difference in terms of functional aspect, with lesser implant-related complication and shorter operative time, PFNA can prove to be a better substitute for the management of these fractures in osteoporotic elderly debilitated patients.

Keywords

• helical blade
• singh’s
• osteoporotic index
• varus collapse
• z-effect