A comparative study of intertrochanteric fractures of hip treated with PFN & PFNA 2

Abstract

Background: Management of intertrochanteric fractures have been evolved from extra medullary implants to intramedullary implants. Intramedullary implants have proven advantage over their counterpart in terms of stable anatomical fixation and better functional outcome. Among the intramedullary implants, Proximal Femur Nail (PFN) & Proximal Femur Nail Anti Rotation for Asia (PFNA2) have been traditionally used. This study is based on the comparison between these two intramedullary implants in terms of clinical and functional outcome. Materials and Methods: A total of 40 patients fulfilling inclusion and exclusion criteria were randomized into two groups PFN (n= 20), PFNA2 (n=20) between August 2018 to July 2019. They were compared in terms of demography, per operative variables, postoperative functional outcome and were followed up for a period of 6 months postoperatively. Results: Average age of PFN group was 61.35 years & PFNA2 was 66.90 years. In PFN group 9 patients (45%) had grade 2 of Singh's osteoporosis index and in PFNA2 12 patients (60%) had grade 2. Mean Harris hip score at 6 months in PFN was 83.15 and in PFNA2 it was 86.80. Complications like infection were seen in 2 patients (10%) in PFN and 1 patient (5%) in PFNA2. Valgus deformity was seen in 1 patient (5%) in PFNA2. Z effect was seen in 4 (20%) in PFN Conclusion: There was no significant difference between the two groups in terms of clinical and functional outcome. However implant related complication's like screw back out, Z effect were not present in PFNA2 and the duration of surgery was less in PFNA2. We conclude that PFNA2 is a better option for treatment of intertrochanteric fractures of hip especially in osteoporotic patients.

Study on functional outcome and mechanical failure in intertrochanteric femur fracture treated with proximal femoral nail antirotation-II

“…1(2.0%) patient in our study had superficial surgical site infection which was completely treated with appropriate intravenous and oral antibiotics (depending on culture reports) for 3weeks. This is comparable with study from Santharam B et al [21] , they noted in PFNA-II group, 2 cases had infection. 1(2.0%) patient in our study developed decubitus ulcer which was successfully managed with regular dressings, which is comparable with study from Harshwardhan H et al [22] , in which they reported 1 case of decubitus ulcer.…”

“…Distribution of mean Harris hip score at 16-weeks post-op follow-up is significantly higher compared to mean Harris hip score at 4-weeks, 8-weeks and 12-weeks post-op follow-up (P-value<0.05 for all). This is comparable to the study of Santharam B et al [21] , Li M et al [18] , and Harshwardhan H et al [22] . Santharam B et al [21] study reported the mean Harris hip score at 6 months in PFNA-II of 86.80.…”

“…This is comparable to the study of Santharam B et al [21] , Li M et al [18] , and Harshwardhan H et al [22] . Santharam B et al [21] study reported the mean Harris hip score at 6 months in PFNA-II of 86.80. Li M et al [18] study reported the mean Harris hip score of 85.6±17.5 (range, 65-100).…”

“…This is concordant to the studies of Santharam B et al21 and Li M et al [18] . Santharam B et al [21] study observed in PFNA-II, 60% had had excellent, 20% had good, 5% had fair and 15% had poor outcome. Li M et al [18] study observed Harris hip score was excellent in 41(25.15%) cases, good in 92(56.44%) cases, moderate in 26(15.95%) cases, and poor in 4(2.45%) cases.…”

A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

“…PFNA2 was introduced for Asian population who has comparatively smaller femur. 13,14 In view of these conditions, this study is taken up to compare the results of DHS and PFNA2 in the treatment of intertrochanteric fractures.…”