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      Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients

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          Abstract

          Objective

          To evaluate long-term radiographic and functional outcomes between dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures (IFFs) among elderly patients

          Methods

          A retrospective comparative study was carried out. Follow-up was performed at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. The primary outcome was the radiographic outcome, and the secondary outcome was the functional outcome.

          Results

          A significant difference in radiographic complications was observed between the DHS group (n = 45, 40.2%) and PFNA group (n = 15, 13.6%). The risk of femoral shaft fracture after implant removal at the 1-year follow-up was increased by 0.9% (n = 1) and 6.3% (n = 7) in the PFNA and DHS groups, respectively. This difference persisted with rates of 3.6% (n = 4) and 12.5% (n = 14) at the final follow-up. Additionally, significant differences were present in the Harris hip score at each visit.

          Conclusion

          Our results indicate that PFNA yields better outcomes than DHS fixation among elderly patients with osteoporotic type 31-A1 IFFs.

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          Most cited references31

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          The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures.

          Muthukrishnan Ramakrishnan, Bilal Malik, Mohan Kamath … (2009)
          PFNA design compacts the cancellous bone to provide increased stability and has been bio-mechanically proven to retard rotation and varus collapse. Between 2006 and 2007, 62 consecutive patients with unstable proximal femoral fractures were treated with the PFNA. Twenty males and 42 females with a mean age of 78 years (44-94) were reviewed. In 48 patients, the fracture resulted from a low energy injury. The majority of the fractures belonged to AO/ASIF types 31A2.3 (22) and 31A3.2 (29). Twelve patients required open reduction. The PFNA blade position was central in 52 patients with a mean tip-apex distance (TAD) of 12 mm (range 4-34 mm). Post-operatively, five patients died within 3 months and two patients were lost to follow-up. Forty-nine fractures united between 3 and 4 months. Four patients had delayed union. The PFNA blade cut out rate was 3.6%. Unstable proximal femoral fractures were treated successfully with the PFNA. The PFNA blade appears to provide additional anchoring in osteoporotic bone. No results have been published on this new design.
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            Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail.

            Christophe Sadowski, Anne Lübbeke, Nicolas Riand … (2002)
            To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures. Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1; n = 106) and those treated by intramedullary nailing (Group 2; n = 100). University Level I trauma center. All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA Type 31-A1 and A2. Treatment with a sliding compression hip screw (Dynamic Hip Screw; Synthes-Stratec, Oberdorf, Switzerland) or an intramedullary nail (Proximal Femoral Nail; Synthes-Stratec, Oberdorf, Switzerland). Intraoperative: operative and fluoroscopy times, the difficulty of the operation, intraoperative complications, and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score. The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively, radiologically, or clinically, between the two groups of patients. There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.
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              TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up.

              Kjell Matre, Tarjei Vinje, Leif Havelin … (2013)
              Both intramedullary nails and sliding hip screws are used with good results in the treatment of intertrochanteric and subtrochanteric fractures. The aim of our study was to assess whether use of the TRIGEN INTERTAN nail, as compared with a sliding hip screw, resulted in less postoperative pain, improved functional mobility, and reduced surgical complication rates for patients with an intertrochanteric or subtrochanteric fracture.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J. Int. Med. Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 18 April 2017
                Publication date (Print): June 2017
                Volume: 45
                Issue: 3
                Pages: 1109-1123
                Affiliations
                [1 ]Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
                [2 ]Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
                [3 ]Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
                [4 ]Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, Guangdong, China
                [5 ]Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang'an District, Wuhan, Hubei, China
                [6 ]Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai City, China
                Author notes
                [*]

                These authors contributed equally to this work.

                [*]Xinchao Zhang, Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai 201508, China. Email: zhangxc401@ 123456aliyun.com
                Article
                Publisher ID: 10.1177_0300060517703277
                DOI: 10.1177/0300060517703277
                PMC ID: 5536426
                PubMed ID: 28417681
                SO-VID: bf1d9979-5ef6-4352-87fb-0d7e2b5b5494
                Copyright © © The Author(s) 2017
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 12 December 2016
                Date accepted : 15 March 2017
                Categories
                Subject: Clinical Reports

                Keywords: intertrochanteric fracture,radiographic complication,proximal femoral nail antirotation,dynamic hip screw,harris hip score
                Data availability:
                Keywords: intertrochanteric fracture, radiographic complication, proximal femoral nail antirotation, dynamic hip screw, harris hip score

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