Surgical Selection of Unstable Intertrochanteric Fractures: Proximal Femoral Nail Antirotation Combined With or Without Cerclage Cable

Abstract

Background: Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation remains challenging for orthopedic surgeons. This study aims to compare the clinical efficacy of proximal femoral nail antirotation (PFNA) combined with a cerclage cable and without a cerclage cable so as to recommend a stable internal fixation method.Methods: From January 2014 to January 2018, we retrospectively analyzed all unstable intertrochanteric fracture cases who received treatment in the Orthopedics Department of our hospital. One hundred and twenty cases were screened, of which 51 were treated with a cerclage cable, and 69 without a cerclage cable. The follow-up period was one year. Patients were divided into either the PFNA and cerclage cable group (PFNA+cable) or the PFNA only (PFNA) group. Results: The Harris hip score (HHS), Barthel Index (BI), and Radiographic Union Scale for Hip (RUSH) were evaluated.The fracture healing and weight-bearing time of the PFNA+cable group were shorter than the PFNA group. Regarding the HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1, 3, 6, and 12 months after the operation. For the HHS rating, the PFNA+cable group had a higher-excellent rate than the PFNA group, with 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. The application of a cerclage cable was found to reduce the incidence of complications.It was found that PFNA combined with a cerclage cable improved the stability of fracture reductions, shortened the fracture healing time and postoperative weight-bearing time, significantly improved patients’ ability to self-care, and reduced the incidence of postoperative complications. Conclusions: Therefore, we think PFNA combined with a cerclage cable is a good choice for patients with unstable intertrochanteric fractures.