A Retrospective Study of 98 Elderly Patients with High-Risk Lateral Femoral Wall Intertrochanteric Hip Fractures to Compare Outcomes Following Surgery with Proximal Femoral Nail Antirotation (PFNA) Versus Dynamic Hip Screw (DHS)

Abstract

Background The aim of this study was to evaluate the efficacy of dynamic hip screw (DHS) and femoral nail antirotation (PFNA) in the treatment of lateral-wall high-risk type of intertrochanteric fractures. Material/Methods A total of 98 patients with high-risk intertrochanteric fractures of the lateral wall who underwent surgery from January 2019 to December 2020 were selected as the study subjects. Of these, 52 were treated surgically with PFNA (mean age 73.45±5.95 years) and 46 with DHS (71.37±6.22 years). We followed up these patients and compared the occurrence of the 2 surgical methods in terms of perioperative period, complication rate, and functional recovery. Results In terms of lateral wall fracture, there were 2 cases of PFNA and 10 cases of DHS, and the difference between groups was statistically significant ( P <0.05). Operative time (mean 54.94±7.29 vs 61.17±6.45) and intraoperative blood loss (72.80±9.18 vs 96.12±8.22) was significantly lower in the PFNA group compared to the DHS group (all P <0.05). Efficacy in the PFNA group was significantly better than in the DHS group. The HHS at follow-up was significantly higher in the PFNA group (mean 80.73±9.20 vs 64.19±8.12) than in the DHS group ( P <0.001). The VAS score at follow-up was significantly lower in the PFNA group (1.78±0.34 vs 2.65±0.23) than in the DHS group ( P <0.001). Conclusions PFNA is more effective than DHS in the treatment of high-risk lateral wall fractures in the elderly, with the advantages of lower incidence of complications and better recovery of hip joint function. PFNA warrants clinical application.

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

“…We limited the population to geriatric intertrochanteric fractures and excluded femoral neck fractures because the two surgical options are completely different and not comparable. We limited the surgical option to the proximal femoral intramedullary nailing technique because it is used more frequently compared to dynamic hip screw for more types of fractures, shorter operative time, less blood, fewer complications, and better function [9,10]. Finally, six high-quality randomized controlled studies [17-20, 25, 26] were included in our study.…”

“…In order to decrease complications and enhance prognosis, it is crucial to reduce perioperative blood loss. Intramedullary nailing is popular due to the bene ts of minimally invasive xation, reliable xation, and low intraoperative blood loss (IBL) [9][10][11]. Although IBL is minimal, it has been noted that HBL in intertrochanteric fractures is signi cantly higher than IBL [12,13].…”

The importance of the thickness of femoral lateral wall for treating intertrochanteric fractures: a finite elements analysis

“…When the lateral wall is vulnerable (AO/OTA subtype-31-A2.2 and A2.3), rupture of the iatrogenic lateral wall can occur during surgery, especially in osteoporotic patients. In these cases, the preference is to use a cephalomedullary nail or P-FLCP 22 , 23 . If the lateral wall is already fractured pre-operatively (AO/OTA subtype-31A3), the general consensus from surgeons is to use an intramedullary nail 24 .…”

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

“…Furthermore, this study focused on geriatric intertrochanteric fractures and excluded femoral neck fractures, as the surgical options for the two types of fractures are distinct and not comparable. The study also restricted the surgical option to proximal femoral intramedullary nailing, which is more commonly used, associated with shorter operative times, reduced blood loss, fewer complications, and improved functionality [ 9 , 10 ]. Ultimately, six high-quality randomized controlled studies [ 17 – 20 , 25 , 26 ] were included in our study.…”