Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures
Keywords:Proximal femoral nail antirotation, Proximal femoral nail, Trochanteric fractures
Background: In the management of peri-trochanteric fractures, intramedullary (IM) devices have proven advantage over extramedullary devices. IM devices allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between IM devices like proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA), the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The following study was undertaken in an attempt to compare these two types of Intra-medullary devices.
Methods: Between January 2012 and June 2013, 50 patients with unstable intertrochanteric fractures fulfilling inclusion and exclusion criteria, were randomized into 2 groups to undergo CRIF with either standard PFN (n=25) or PFNA (n=25). They were compared in terms of demography, per-operative variables and postoperative parameters including functional evaluation till 1year postoperatively.
Results: Background demographic variables, fracture type and pre-injury ambulatory status were comparable between the groups. Operative duration of surgery, amount of blood loss and number of fluoroscopic images were significantly lower in PFNA group as compared to PFN group. Post op complications like infection, non-union, cut out/z-effect, loss of reduction, re-operation and mortality rates didn’t differ significantly between the groups. Post op functional recovery as evaluated by pain, use of walking aids and Harris hip scores were similar in both groups.
Conclusions: PFNA significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFNA offers no significant benefits over PFN in terms of post-operative functional recovery or complications.
Xu YZ, Geng DC, Mao HQ, Zhu XS, Yang HL. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res. 2010;38(4):1266–75.
Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br. 1992;74(3):340-4.
Akıncı O, Akalın Y, Reisog˘lu A, Kayalı C. Comparison of long-term results of dynamic hip screw and AO 130 degrees blade plate in adult trochanteric region fractures. Acta Orthop Traumatol Turc. 2010;44(6):443–51.
Sadowski C, Lu¨bbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002;84(3):372–81.
Haidukewych G, Israel A, Berry D. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2001;83:643–50.
Zeng C, Wang YR, Wei J, Gao SG, Zhang FJ, Sun ZQ, et al. Treatment of trochanteric fractures with proximal femoral nail antirotation or dynamic hip screw systems: a meta-analysis. J Int Med Res. 2012;40(3):839-51.
Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, et al. Treatment of trochanteric fractures with the proximal femoral nail antirotation (PFNA) nail system – report of early result. Bull NYU Hosp Jt Dis. 2008:66(4):276-9.
Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35.
Mora A, Marimon I, Rius M, Brill W, Corral A, Gaya S. PFN versus PFNA in treatment of trochanteric femoral fractures: A prospective study. Bone and joint journal Orthopaedic proceedings. 2011;93(2):136.