Effect of proximal femoral nail antirotation on clinical outcome, inflammatory factors and myocardial injury markers in patients with femoral trochanteric fracture

Abstract

Objective: To compare the differences between proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in treatment of femoral trochanteric fracture and analyze the factors influencing recovery after PFNA treatment.

Methods: Eighty-six patients with femoral trochanteric fracture admitted to Taizhou Hospital of Traditional Chinese Medicine between January 2019 and June 2021 were enrolled in the study and assigned into a PFNA group and DHS group (n=43 in each group) before undergoing these treatments. The clinical efficacy, inflammatory factors, and myocardial injury markers were compared between the two groups. The influencing factors on recovery after PFNA treatment were analyzed by univariate and multivariate analysis.

Results: Compared to the DHS group, the PFNA group had shorter surgical time, length of stay in hospital, postoperative weight-bearing time, time of healing and detumescence, and less intraoperative blood loss (all P<0.001). The incidence of post-surgical complications with PFNA was lower than with DHS (P<0.05). The serum levels of interleukin-6, C-reactive protein and tumor necrosis factor-αof the PFNA group were lower than those of the DHS group (all P<0.05). Moreover, the serum levels of cardiac troponin T, creatine kinase-MB and myoglobin in the PFNA group were also lower than for the DHS (all P<0.05). At the first, third, and sixth months after surgery, the Harris scores for PFNA were higher than for DHS (all P<0.05). The univariate and multivariate analysis showed that instability of fracture, history of osteoporosis, excessive intraoperative bleeding, poor compliance with rehabilitation exercise, and long time from injury to surgery were risk factors for poor recovery following PFNA treatment for patients with femoral trochanteric fracture.

Conclusion: Compared to DHS, PFNA had better clinical efficacy and gave lower serum levels of inflammatory factors and myocardial injury markers. Fracture classification, history of osteoporosis, intraoperative amount of bleeding, compliance of rehabilitation exercise, and time from injury to surgery were closely associated with recovery following PFNA treatment.

Keywords: Femoral intertrochanteric fracture; dynamic hip screw; proximal femoral nail antirotation; recovery effects; risk factors.

Figure 1

Comparison of serum inflammatory factors between the PFNA group and DHS group. Compared to DHS group after treatment, *P<0.05. Compared to before treatment in the same group, #P<0.05. A: The level of CRP. B: The level of IL-6. C: The level of TNF-α. Note: DHS: Dynamic hip screw; PFNA: Proximal femoral nail antirotation; CRP: C-reactive protein; IL-6: Interleukin-6; TNF-α: tumor necrosis factor-α.

Figure 2

Comparison of myocardial injury markers between the PFNA group and DHS group. Compared to DHS group after treatment, *P<0.05. Compared to before treatment in the same group, #P<0.05. A: The level of cTnT. B: The level of CK-MB. C: The level of Myo. Note: DHS: Dynamic hip screw; PFNA: Proximal femoral nail antirotation; cTnT: cardiac troponin T; CK-MB: creative kinase isoenzyme MB; Myo: myohemoglobin.