Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul-Aug;10(4):779-784.
doi: 10.1016/j.jcot.2018.07.012. Epub 2018 Jul 23.

Screw versus helical proximal femoral nail in the treatment of unstable trochanteric fractures in the elderly

Col Narinder Kumar  1 , Maj P K Srivastava  2
Affiliations

Screw versus helical proximal femoral nail in the treatment of unstable trochanteric fractures in the elderly

Col Narinder Kumar et al. J Clin Orthop Trauma. 2019 Jul-Aug.

Abstract

Purpose: Comparison of clinical, radiological and functional outcomes of screw proximal femoral nail (PFN) and helical PFN in management of unstable trochanteric fractures.

Methods: This prospective randomised comparative study included 60 patients with closed unstable intertrochanteric fractures (AO classification-A2.2-A2.3 & A3.1-A3.3). Patients were randomised to 2 treatment groups using simple random sampling method utilizing computer based randomisation. Screw PFN and helical PFN were used for internal fixation with 30 patients in each group.

Results: Both groups were similar in respect of age, gender, fracture classification, quality of fracture reduction, duration of hospitalization, post-operative complications, residual/late deformity as well as functional assessment. However, mean duration of surgery was significantly lower (23.1%) in helical PFN group as compared to screw PFN group (43.32 ± 8.20 min vs. 35.20 ± 6.03 min, p < 0.001). Furthermore, mean blood loss was not significant in either of the study groups but it was significantly lesser (30.1%) in helical PFN group as compared to screw PFN group (77.80 ± 17.39 ml vs. 59.80 ± 14.96 ml, p < 0.001). Also, mean number of images taken was significantly lower (58.7%) in helical PFN group as compared to screw PFN group (29.52 ± 4.85 no vs. 18.60 ± 3.12 no, t = 9.47; p < 0.001).

Conclusion: Both screw PFN and helical PFN are equally effective implants in internal fixation of unstable trochanteric fractures with no statistically significant difference (p > 0.05) in any of the outcome measures. However, helical PFN group fared marginally better in terms of operative time, blood loss and imaging required.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Representative case of unstable trochanteric fracture managed by screw PFN (Serial X-rays- Preoperative to fracture union).
Fig. 2
Fig. 2
Representative case of unstable trochanteric fracture managed by helical PFN (Serial X-rays- Preoperative to fracture union).
See this image and copyright information in PMC

References

    1. Gullberg B., Johnell O., Kanis J.A. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407–413. A journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. - PubMed
    1. Kanis J.A., Johnell O., De Laet C., Jonsson B., Oden A., Ogelsby A.K. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002;17(7):1237–1244. The official journal of the American Society for Bone and Mineral Research. - PubMed
    1. Smektala R., Ohmann C., Paech S. On the prognosis of hip fractures. Assessment of mortality after hip fractures by analyzing overlapping segments of longitudinal data. Unfallchirurg. 2005;108(11):927–928. 30-37. - PubMed
    1. Johnell O., Kanis J.A. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004;15(11):897–902. A journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. - PubMed
    1. Willoughby R. Dynamic hip screw in the management of reverse obliquity intertrochanteric neck of femur fractures. Injury. 2005;36(1):105–109. - PubMed