Comparative Study of Functional and Radiological Outcome of Pertrochanteric Fracture Fixation by Proximal Femoral Nail Antirotation 2 and Old Proximal Femoral Nail

Abstract

Abstract Context: Pertrochanteric fractures include the fractures in the region which extend from the extracapsular basilar neck region to the region along the lesser trochanter of femur. Pertrochanteric femur fracture accounts for the most common hip fracture. Most of pertrochanteric fractures, in younger as well as in the elderly patients, are unstable and slightly or partially displaced and require operative intervention. There are different types of fixation for pertrochanteric femur fracture such as proximal femoral nail (PFN), proximal femoral nail antirotation-2 (PFNA-2), Dynamic hip screw (DHS), Dynamic condylar screw (DCS), and angled blade plate. The PFNA-2 has been introduced to reduce implant-related complications, operative time, and intraoperative blood loss, especially in elderly osteoporotic individuals. This study was done with the belief that unstable pertrochanteric fractures can be better reconstructed with PFNA-2 designed specifically for the Asian population than with PFN and thereby enhance the functional outcome. Materials and Methods: A total of 40 patients were selected randomly. The fracture pattern included for the study was pertrochanteric fracture of the femur. The selection was based on performed inclusion and exclusion criteria. The functional outcomes and clinical results of the patients were evaluated and graded using the Harris hip score. Statistical Analysis Used: Statistical package for the social sciences software version 22.0 (IBM software package) was used for statistical analysis. Results: In our study, there were 20 (50%) patients who were treated with PFN and 20 (50%) were treated PFN-A2. The mean age in the PFN group was 43.90 ± 16.88 years and in the PFNA-2 group was 47.80 ± 17.25 years. In the PFNA-2 group, the average time of surgery was 67.00 min, and with PFN, the average time of surgery was 90.25 min. Mean intraoperative blood loss, in the PFNA-2 group was 68.25 ± 5.20 mL and in the PFN Group, it was 86.50 ± 10.37 mL. The group with PFN-A2 had a better hip score when compared with the PFN group. The complication rates were significantly lower in the PFN-A2 group. Conclusions: The newer alternative PFNA-2 was found to be much better than PFN in terms of lesser surgical time, small incision resulting in lesser blood loss, lesser number of image intensifier shoots, lesser duration of surgery, and advantage of compression mechanism at fracture site and lesser chances of biomechanical failure compared to PFN.