Comparison of reconstruction of lateral femoral wall or not to operative effect of femoral intertrochanteric fracture treated with PFNA

Abstract

Objective To compare the clinical efficacy of PFNA combined with locking reconstruction plate and PFNA for femoral intertrochanteric fractures of lateral wall fractue. Methods A retrospective study was conducted on 50 patients who received PFNA for femoral intertrochanteric fractures complicated with lateral wall fractures in our department from January 2017 to December 2021. According to the preoperative doctor-patient communication, 26 patients underwent PFNA and lateral wall reconstruction with a locking plate (group A), while the other 24 patients received PFNA alone (group B). The perioperative period, follow-up and imaging data of the two groups were compared. Results All the patients were operated on smoothly without nerve and vascular injury. Although there were no significant differences in operation time, intraoperative blood loss, total incision length, intraoperative fluoroscopy times, success rate of the first nail placement, screw blade length, incision healing grade and hospital stay between the two groups (P>0.05), the group A resumed ambulation significantly earlier than the group B [((14.01±1.62) days vs (18.83±2.94) days, P< 0.05]. All patients in both groups were followed up for an average of (23.98±4.41) months, and the reconstruction group returned to full weight- bearing activity significantly earlier than the non-reconstructed group [(13.46±3.51) weeks vs (16.5±3.02) weeks, P<0.05]. The Harris score, hip extension-flexion range of motion (ROM) and adduction- abduction ROM significantly increased in both groups with postoperative time (P<0.05), which in the group A proved significantly better than those in group B at all time points accordingly (P<0.05). Radiologically, there was no significant difference in reduction quality between the two groups (P>0.05). At the last follow- up, the group A was also significantly superior to the group B in terms of neck-shaft angle (NSA) [(127.54±2.76)° vs (125.79±1.44)°, P<0.05] and extent of femoral head-neck shortening [(4.06±0.70) mm vs (5.04± 0.62) mm, P<0.05]. Conclusion The lateral wall reconstruction in PFNA fixation of femoral intertrochanteric fractures does enhance the stability of fixation, facilitate the functional recovery of hip joint and reduce complications in this study.