Comparison of functional and radiological outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA in patients with osteoporosis

Abstract

Introduction: Unstable intertrochanteric fracture poses challenges in terms of obtaining stable fixation and good post-operative outcomes. There is a paucity of clinical data comparing the commonly used proximal femoral nail (PFN) and PFN anti-rotation (PFNA) implants, especially in relation to osteoporosis. The purpose of this study is to assess the comparative performance of PFN and PFNA fixation in the treatment of unstable femur intertrochanteric fractures.

Materials and methods: This prospective observational study was conducted to understand and analyze the advantages of PFNA over PFN in the management of unstable intertrochanteric fractures from May 2021 to October 2023 at the Department of Orthopaedics, Chettinad Hospital and Research Institute, Kelambakkam. Patients presenting with an unstable intertrochanteric fracture with Singh's Index grades 1, 2, and 3 were included. Boyd and Griffin classification types 2, 3, and 4 were included in the study. The patients were randomized into two types of implant groups. All patients were operated with a standard protocol. Patients were followed up for a minimum of 6 months and any complications were noted. A comparison of functional outcomes was done using the Modified Harris Hip Score. Statistical analysis was done using the unpaired t-test/Mann-Whitney U test and Chi-square test/Fisher's exact test. A P < 0.05 was considered significant.

Results: Every follow-up period included a Harris Hip Score assessment. At 3 months, the average score of PFN was 71.9 (range 66-81) and at 6 months it was 77.86 (range 72-90). For PFNA, at 3 months, the average score was 74.87 (range 66-81), and at 6 months, it was 89.3 (range 76-94). The improvement was seen well in the PFNA group which is statistically significant (P = 0.023). The most prevalent fracture was a type 2 fracture.

Conclusion: The results showed PFNA has better rotation stability with single screws and better functional outcomes in treating unstable intertrochanteric fractures when compared to PFN.

Keywords: Proximal femoral nail; communicated fragments; lateral trochanteric wall; unstable trochanteric fracture.

Figure 1

Initial pre-operative X-rays (proximal femoral nail).

Figure 2

Immediate post-operative X-rays (proximal femoral nail).

Figure 3

3 months follow-up X-rays (proximal femoral nail).

Figure 4

6 months follow-up X-rays (proximal femoral nail).

Figure 5

Initial pre-operative X-rays (proximal femoral nail anti-rotation).

Figure 6

Immediate post-operative X-rays (proximal femoral nail anti-rotation).

Figure 7

3 Months follow-up X-rays (proximal femoral nail anti-rotation).

Figure 8

6 Months follow-up X-rays (proximal femoral nail anti-rotation).