Comparison of efficacy, complications and TGF‑β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture

Abstract

The aim of the present study was to compare the efficacy and complications of two fixation techniques, namely dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA), in the treatment of osteoporotic femoral intertrochanteric fracture in elderly patients, and to detect changes in transforming growth factor β2 (TGF-β2) expression in the two groups. A total of 100 elderly patients with femoral intertrochanteric fracture were randomly divided into two groups that were treated with either DHS or PFNA. Peri-operative complications were observed in the patients and ELISA was used to detect TGF-β2 expression levels at 1, 7, 15 and 30 days after surgical treatment. The clinical efficacy and the incidence rate of complications at 3 months after the operation were compared. In comparison with the DHS group, the PFNA group had a shorter operation time, a lower bleeding volume and a shorter post-operative weight-bearing time. The contents of TGF-β2 in the two groups at 7 days after the operation were higher than those at 1 day, reached a peak at 15 days and had gradually decreased again at 30 days after the operation. The contents of TGF-β2 at 1, 7 and 15 days in the PFNA group were higher than those at the identical time-points in the DHS group (P<0.01). Regarding the clinical efficacy in the two groups at 3 months of post-surgery, the rate of excellent/good efficacy in the PFNA fixation group (90.0%) was higher than that in the DHS fixation group (74.0%). Of note, PFNA fixation had a higher clinical efficacy, a shorter operation time, less intra-operative trauma, a relatively faster fracture healing process and fewer complications in comparison with DHS fixation, and is therefore more suitable for treating osteoporotic femoral intertrochanteric fracture in the elderly. PFNA fixation is superior to DHS fixation, which may be associated with the higher level of TGF-β2 expression in comparison with that in the DHS group.

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…No association was reported between extramedullary DHS and derotation screw alone or with trochanteric wiring [81], Minimally invasive DHS and conventional DHS [62], and weight bearing. The studies that compare different types of extramedullary and intramedullary implants report facilitators of weight bearing favouring PFNA-II (compared with dynamic hip locking plates (DHLP)) [95], PFNA (compared with DHS) [52,65,72,94,96], PFN (compared with DHS) [68,76,77], short PFN (compared with DHS) [78], Mini-invasive static nail (compared with conventional DHS) [56], and gamma nail (compared with DHS) [71]. No difference between extramedullary and intramedullary implants was reported in two studies [54,85].…”

“…Okkaoğlu 2020 [79] − Tao 2013 [97] ✓ (B) Shu 2020 [84] ✓ (A) Peyser 2007 [80] ✓ (B) Torres 2014 [92] ✓ (B) Lunsjo 1999 [73] ✓ (D) Xie, 2017 [95] ✓ (B) Leung 1992 [71] ✓ (B) Duymus 2019 [58] ✓ (B) Kamboj 2019 [68] ✓ (B) Mayi 2016 [76] ✓ (B) Meesala 2018 [77] ✓ (B) Huang 2017 [65] ✓ (B) Chen 2018 [52] ✓ (B) Li 2018 [72] ✓ (B) Wang 2019 [94] ✓ (B) Xu 2018 [96] ✓ (B) Nargesh 2013 [78] ✓ (B) Singh 2021 [85] − Darbandi 2022 [54] − Dujardin 2001 [56] ✓ (B) Sandhu 2019 [82] ✓ (B) Jianbo 2019 [66] ✓ (A) Kaneko 2004 [69] ✓ (A) Karaali and Ciloglu 2021 [70] ✓ (B)…”

Reinforced Screw Fixation of Severe Osteoporotic Intertrochanteric Femur Evans II Fracture Biomechanics Biomechanical Finite Element Analysis

“…However, some internal xation failures (screw removal, cutting, etc.) still occur (the incidence is about 3%-15%) [5][6] , and the severity of osteoporosis is considered to be the main factor [7][8] . Patients with severe osteoporosis are particularly vulnerable to trabecular bone and have a higher probability of internal xation failure [9].…”

Surgical Selection of Unstable Intertrochanteric Fractures: PFNA Combined with or without Cerclage Cable

“…As a result of gypsum fixation is easy to cause pulmonary infection, venous thrombosis, malnutrition, bedsore, urinary system infection, joint stiffness, and other complications, so choose a surgical remedy is the optimal therapeutic regimen. PFNA, DHS, PFN, Intertan, and Gamma are the most common fixation methods for unstable intertrochanteric fractures [ 6 , 7 ]. Among them, PFNA has the advantages of small incision, less bleeding, and firm fixation, but the operation of PFNA is highly required of skill [ 8 ].…”