Comparative outcome of short proximal femoral nail versus proximal femoral locking compression plate in the management of unstable trochanteric fractures

Abstract

Introduction: Trochanteric fractures are mostly due to RTA and falls. Unstable trochanteric fractures include those with a reverse oblique fracture line, intertrochanteric comminution, big posteromedial fragment, subtrochanteric extension, a broken greater trochanter, and lateral cortex breach. As per the AO Classification of intertrochanteric fractures, AO31-2.2, AO31-2.3, AO31-3.1, AO31-3.2, and AO31-3.3 fall under the category of unstable trochanteric fractures. Internal fixation is mandatory to provide early mobilization of patients with partial weight-bearing and prevent further complications.Materials and Methods 43 patients more than 18 years old with unstable trochanteric fractures, less than 3 weeks old trauma were included in the prospective study for 1 year period (1st June 2020 to 31st May 2021). 22 cases were treated with short proximal femoral nail (PFN) and 21 cases were treated with proximal femoral locking compression plate (PFLCP).Results (P < 0.05), mean duration of surgery, blood loss was less in the PFN group (67minutes; 80mL) than PFLCP group (99minutes; 152mL). Union and partial weight-bearing was seen earlier in PFN group (14.1weeks; 10.6weeks) than in PFLCP group (18.7 weeks; 15.8weeks) (P < 0.05). Good-excellent outcome was seen in 100% cases in PFN group and 85.71% cases in PFLCP group. There were 3 cases of delayed union in PFLCP group and 1 in PFN group. 1 PFLCP case had malunion in varus deformity.Conclusion Short PFN is the optimum implant in treatment of unstable trochanteric fractures as it is an intramedullary, load sharing device with short lever arm and hastens biological healing with early ambulation and minimal complications.