Outcomes of Intertrochanteric Femur Fractures Treated with Proximal Femoral Nail and Proximal Femoral Nail Anti-Rotation Ii in Elderly Patients – A Randomized Controlled Trial

Abstract

Background: Internal fixation is the most common surgical treatment for intertrochanteric fractures, and intra-medullary (nails) and extra-medullary (screws or plates) fixations are two commonly used implants or appliances. The established benefits of internal fixation treatments are immediate pain relief, mobilization, faster rehabilitation and maintenance of independent living in these patients. The PFNA by using a single helical blade was designed to achieve better stabilization of the intertrochanteric fractures rather than a screw system or double screw fixation like in PFN for fixation. The helical blade increases the bone-implant interface and result in compaction of cancellous bone, thereby providing excellent stability of fixation.

Methods: A Randomized Controlled Trial of 60 patients carried out in Department of Orthopaedics of Tertiary care teaching hospital during period of October 2018 till February 2020. Patients with unstable intertrochanteric fractures fulfilling inclusion and exclusion criteria, were randomized into 2 groups to undergo CRIF with either standard PFN (n=30)or PFNA-II (n=30). They were compared in terms of demography, per-operative variables and postoperative parameters including functional evaluation till 6 months and 1 yr postoperatively.

Results: Background demographic variables, fracture type and pre-injury ambulatory status were comparable between the groups. The average operative time, radiation exposure and blood loss in osteosynthesis with proximal femoral nail antirotation-II is significantly less in comparison with proximal femoral nail. Also local and systemic complications are negligible thereby reducing hospital stay.

Conclusions: Osteosynthesis with proximal femoral nail antirotation-II significantly reduces The average operative time, radiation exposure and blood loss as compare to proximal femoral nail. Also local and systemic complications are negligible thereby reducing hospital stay.