A Retrospective Study of 98 Elderly Patients with High-Risk Lateral Femoral Wall Intertrochanteric Hip Fractures to Compare Outcomes Following Surgery with Proximal Femoral Nail Antirotation (PFNA) Versus Dynamic Hip Screw (DHS)

Abstract

BACKGROUND The aim of this study was to evaluate the efficacy of dynamic hip screw (DHS) and femoral nail antirotation (PFNA) in the treatment of lateral-wall high-risk type of intertrochanteric fractures. MATERIAL AND METHODS A total of 98 patients with high-risk intertrochanteric fractures of the lateral wall who underwent surgery from January 2019 to December 2020 were selected as the study subjects. Of these, 52 were treated surgically with PFNA (mean age 73.45±5.95 years) and 46 with DHS (71.37±6.22 years). We followed up these patients and compared the occurrence of the 2 surgical methods in terms of perioperative period, complication rate, and functional recovery. RESULTS In terms of lateral wall fracture, there were 2 cases of PFNA and 10 cases of DHS, and the difference between groups was statistically significant (P<0.05). Operative time (mean 54.94±7.29 vs 61.17±6.45) and intraoperative blood loss (72.80±9.18 vs 96.12±8.22) was significantly lower in the PFNA group compared to the DHS group (all P<0.05). Efficacy in the PFNA group was significantly better than in the DHS group. The HHS at follow-up was significantly higher in the PFNA group (mean 80.73±9.20 vs 64.19±8.12) than in the DHS group (P<0.001). The VAS score at follow-up was significantly lower in the PFNA group (1.78±0.34 vs 2.65±0.23) than in the DHS group (P<0.001). CONCLUSIONS PFNA is more effective than DHS in the treatment of high-risk lateral wall fractures in the elderly, with the advantages of lower incidence of complications and better recovery of hip joint function. PFNA warrants clinical application.