The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients

Abstract

Background: The best options of internal fixation for unstable intertrochanteric fractures in elderly Chinese patients remain controversial. The Asia proximal femoral nail antirotation (PFNA-II) was specifically designed for Asian patients, which could be more effective than the regular proximal femoral nail antirotation (PFNA). Compared to PFNA, whether PFNA-II is associated with shorter operative time and lower rates of complications is unknown.

Hypothesis: The rate of complications using PFNA-II is lower than PFNA for the treatment of unstable intertrochanteric fractures in elderly Chinese patients, and the operation using PFNA-II is quicker.

Materials and methods: Between June 2008 and December 2011, 188 patients with unstable intertrochanteric fractures treated with the PFNA-II (n=118) or PFNA (n=70) were retrospectively evaluated. Follow-up evaluations were performed at 1, 3, 6, 9 and 12 months, and every year thereafter. According to residual valgus-varus deformation, the quality of the fracture reduction was graded as poor (>10° deformation), acceptable (5° to 10° deformation), or good (<5° deformation). The operative time, intraoperative blood loss, overall time of fluoroscopy, blood transfusion volume, postoperative drainage, length of hospital stay and postoperative complications were recorded.

Results: The mean operative time in the PFNA-II group was significantly shorter than that in the PFNA group (66.25±13.15 vs 79.50±21.12 minutes; P<0.05), intraoperative blood loss was smaller (131.86±69.16 vs 162.14±66.18 mL; P<0.05), and fewer local complications were observed (25% vs 46%; P<0.05). There was no significant difference in the postoperative blood transfusions, overall time of fluoroscopy, postoperative drainage, length of hospital stay, fracture reduction, the position of the implant and tip apex distance between the two groups. At follow-up, no significant difference was found between the two groups in Harris hip score (HHS) (86.19±6.53 vs 85.27±5.47; P>0.05), visual analogue scale (VAS) (0.87±0.85 vs 0.97±0.87; P>0.05).

Discussion: Due to its special design for the Asian population, PFNA-II offers a better match with the Chinese people's proximal femur anatomic structure. This study showed that the rate of complications using PFNA-II is lower than PFNA for the treatment of unstable intertrochanteric fractures in elderly Chinese patients, and the operation time is shorter.

Level of evidence: Level III, case control study.

Keywords: Chinese; PFNA; PFNA-II; Unstable intertrochanteric fractures.