Proximal femoral nail antirotation versus external fixation for unstable intertrochanteric fractures in elderly patients: A randomized controlled trial

Abstract

Background: This study aimed to compare the clinical and radiographic outcomes of the proximal femoral nail antirotation (PFNA) and external fixation in the management of unstable intertrochanteric fractures in elderly patients.Methods: Eighty-seven of 114 patients with unstable intertrochanteric fractures were included in this study between January 2015 and June 2019, 46 were fixed with PFNA implant and 41 with external fixator. Patient baseline characteristics, functional and radiographic results, and postoperative complication were documented and compared between the 2 groups.Results: Prolonged operation duration, increased fluoroscopy time, and excess blood loss occurred in PFNA group. The functional results scores seemed higher in the PFNA than external fixation group in the first semester, and thereafter, there was no significant difference between groups. On early postoperative radiographs, better femur neck-shaft angle was acquired in the external fixators device, but the difference did not continue at final visit. The incidence rate of overall complications was 43.5% for the group PFNA and 100% for the group external fixation.Conclusions: Fewer postoperative complications occurred in PFNA than external fixator group when unstable intertrochanteric fractures were treated. Nevertheless, there was no significant difference detected in final functional and radiographic outcome between the 2 groups.

Evaluating the Impacts of Proximal Femoral Nail Anti-Rotation (PFNA) Augmentation in Osteoporotic Intertrochanteric Fractures

“…Functional outcomes in PFNA were superior to those in external fixation. External fixation did not result in fewer overall problems than PFNA (Liang et al, 2022). In a comparative study between Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) for intertrochanteric hip fractures, PFN performed better in terms of range of motion, limb length discrepancy, blood loss, postoperative pain, and infection incidence (Gill et al, 2017).…”

A comparison of functional and radiological outcome of combine compression antegrade intertrochanteric nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in elderly patients with intertrochanteric fractures

“…5 Recent clinical research data is available on the use of InterTan and PFNA-II in patients with intertrochanteric fractures, however the choice of device is still controversial. [6][7][8] The purpose of this study was to compare the impact and safety of InterTan and PFNA-II in the treatment of intertrochanteric fractures on patients' functional rehabilitation. Our aim to provide a reference for improving the prognosis of patients with intertrochanteric fractures and selecting the appropriate device.…”