Publication:

Comparative study to assess the functional outcome in management of inter-trochanteric fractures by proximal femoral nail versus proximal femoral nail anti-rotation

Background Proximal femoral fractures are one of the most common fractures occurring in elderly due to osteoporosis and increase in life expectancy. The management of these fractures poses a serious challenge in terms of obtaining a stable fixation and a good post-operative outcome. In this study, we compare two intramedullary devices: Proximal femoral nail (PFN) and proximal femoral nail anti-rotation (PFN-A), used commonly for the fixation of proximal femoral fractures.

Methods Patients presenting with inter-trochanteric fractures were included and randomly allocated to two groups for treatment with either PFN or PFN-A. Pre-operative radiographs of normal side were used to grade osteoporosis by Singh’s index. Post-operative radiographs were used to assess the tip-apex distance and quality of reduction. Functional outcome was compared on the basis of Harris hip score at final follow-up. Patients were followed up at an interval of 1, 3 and 6 months respectively.

Results The study included 30 patients with 15 patients in each group. The duration of surgery and blood loss was significantly less in PFN-A group as compared to PFN. Functional outcome as assessed by Harris hip score was similar in both the groups. Implant related complications, though less in PFN-A group, had statistically insignificant difference.

Conclusions It can be safely concluded that, in spite of no differences in functional outcome between the two groups, a shorter duration of surgery and less blood loss would still make PFN-A a better choice in such patients, especially the elderly and co-morbid/compromised patients.