Proximal Femoral Nail versus Proximal Femoral Nail Antirotation: Functional and Radiological Outcome in Intertrochanteric Fractures of Femur

Abstract

Introduction

Newer implant designs such as Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFN-A) have shown promising results in the treatment of intertrochanteric fractures. Despite the availability of various implants for the treatment of these fractures, there is no common consensus as to which implant would be ideal. Therefore, there is a need for further clinical trials to establish the biomechanical and functional outcome superiority of implants such as PFN and PFN-A, especially among osteoporotic patients.

Aim

To compare the functional and radiological outcomes in intertrochanteric patients treated with PFN and PFN-A.

Methodology

A total of 152 intertrochanteric fracture patients were included in this retrospective study, 94 in the PFN group and 58 in the PFN-A group. The postoperative radiological outcome was assessed and compared using parameters such as tip-apex distance (TAD), Cleveland index, neck-shaft angle, and type of reduction. Operative time for the procedure, pre and postoperative hemoglobin levels were recorded and compared. Fracture union rates were compared at six weeks and six months. Functional outcome was compared between the two groups at follow-up period of 6 months using Harris Hip Score (HHS) and pre and postoperative Parker Palmer Mobility Score (PPS). Complication rates were compared between the two groups. Also, osteoporotic patients were evaluated using the same parameters.

Results

The radiological parameters were similar in both groups. There was a shorter operative time and better hemoglobin levels after surgery in the PFN-A group. The complication rate in the PFN group was 7.4% when compared to the PFN-A group which was just 1.7%. The functional outcome based on HHS and PPS was alike in the two groups. In osteoporotic patients randomized based on Singh’s index, better union rates were observed in the PFN-A group and a higher complication rate was seen in the PFN group.

Conclusion

Cephalomedullary nailing using PFN-A is superior to PFN in terms of a lesser procedure time, minimal blood loss, and fewer complications even among osteoporotic patients. The radiological specifications such as neck-shaft angle post-surgery, reduction type, TAD, and Cleveland index is of paramount importance which is established in this study.