Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures

Abstract

Introduction: Comparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF). Methods: Evaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS). Results: A statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001). Conclusion: The new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.

Sliding hip screw vs intramedullary nail for AO/OTA31A1-A3: a systematic review and meta-analysis

“…Deceased patients who were excluded from the studies' final analyses were included in this study's analysis. This was not possible for Duymus et al, [57] as the number of deceased patients excluded was unavailable.…”

Relationship between Charlson comorbidity index, early recovery and 2-year mortality in elderly patients undergoing surgical treatment of inter-trochanteric fractures: a retrospective analysis

“…Duymus et al compared the result of intra- and extramedullary implants in treatment of intertrochanteric fractures and found that proximal femoral nail had better clinical results. The full weight-bearing time was significantly reduced to 1.25 ± 0.40 months 21 .…”

Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

“…All of these factors may have influenced the identification of the osseous union and affected the assessment of complications. Third, we also could not clearly document when the patient started weight bearing even though some studies regard the time to weight bearing as an important parameter for evaluating the stability of implant fixation [25,26]. A comparison of surgical incision length between the two implants was also not performed in our study.…”