Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures

Abstract

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.