The PFNA in treatment of intertrochanteric fractures with or without lateral wall fracture in elderly patients: a retrospective cohort study

Abstract

Background There is no consensus about intertrochanteric fractures with lateral wall treated with intramedullary nail—proximal femoral nail antirotation (PFNA). The aim of the present study was to compare function outcomes between lateral wall and no lateral wall fractures after surgery by PFNA. Methods This retrospective study evaluated patients with or without lateral wall fractures who underwent PFNA between January 2015 and June 2018. The operative time, intraoperative blood loss, time to fracture healing, complications and functional outcomes qualified by Harris hip score and Parker − Palmer mobility score (PPMS) were compared between the two groups. Results Two groups were comparable with regard to patient age, sexual distribution, mechanism of injury, fracture type, body mass index (BMI), Time to surgery, American Society of Anesthesiologists (ASA) score and quality of reduction. The incomplete group had a longer operation time (54.1 ± 8.74 min vs. 51.0 ± 9.86 min) and more intraoperative blood loss (228.4 ± 48.8 ml vs. 151.3 ± 43.5 ml) in comparison with the control group (P < 0.01). Regarding functional outcome, the HHSs of the two groups were 76.2 ± 11.6 vs 75.6 ± 12.5 at the 3 months (P = 0.603), 81.9 ± 9.4 vs 82.6 ± 8.7 at the six months (P = 0.224), 83.8 ± 6.6 vs 84.5 ± 6.0 at the twelve months 85.2 ± 5.5 vs 86.0 ± 5.8 at the twenty-four months (P > 0.05), respectively. Similar results were obtained about PPMS. We found no difference in Weight bearing time, Time of fracture healing, and Complications between incomplete group and intact group. Conclusions There is no substantial difference in functional results or complication rates for intertrochanteric fractures with lateral wall fractures, except from increased blood loss and operation time. We believe that an intramedullary nail will be sufficient to repair an intertrochanteric fracture with or without a lateral wall fracture.

Comparative Analysis of Functional and Radiological Outcomes Between Proximal Femoral Nail Anti-Rotation 2 and Conventional Proximal Femoral Nail at School of Medical Science and Research, Sharda University Greater Noida: A Prospective Observational Study.

“…Employing surgical treatment involving internal fixation for these fractures offers several advantages, such as enhancing patient comfort, simplifying nursing care, reducing the length of hospitalization, and minimizing the complications associated with prolonged bed rest. (2) Unstable femoral intertrochanteric fractures (classified as AO 31A2 and AO 31A3) remain a complex issue for orthopedic surgeons. Despite achieving high rates of bone union, these fractures often result in suboptimal functional outcomes.…”