The Unstable Trochanteric Fractures Treated with Proximal Femoral Nail Antirotation versus Sliding Hip Screw

Article Sidebar

pdf
Published: Oct 31, 2015
Keywords:
Proximal femoral nail antirotation sliding hip screw trochanteric fractures

Main Article Content

Thananit Sangkomkamhang, MD
Department of Orthopedic Surgery, Khon Kaen Regional Hospital, Khon Kaen, Thailand

Abstract

Purpose: To compared the complications and functional outcomes of patients with unstable trochanteric fractures AO/OTA 31-A2 treated with a proximal femoral nail antirotation (PFNA) device versus sliding hip screw (SHS).
Methods: A prospective randomized study of patients with unstable trochanteric fractures AO/OTA 31-A2 from January 2010 to December 2012 was performed. A total of 181 patients were randomized into two groups: the PFNA group (n = 95) and the SHS group (n = 86). Perioperative and postoperative data, functional outcomes, and complications were recorded and assessed.
Results: Although the reoperation rate was lower in the PFNA group than in the SHS group, there was no significant difference between the reoperation rates of the two groups in the patients with unstable trochanteric fractures. There was also no significant difference in functional outcome between the PFNA group and the SHS group. The SHS group had a prolonged operative time and produced more blood loss than the PFNA group.
Conclusion: For treatment of unstable trochanteric fractures (AO/OTA 31-A2) of proximal femur, the sliding hip screw should remain the standard treatment of care. However, the PFNA device is still useful for the treatment of unstable trochanteric fractures (AO/OTA 31-A2) that involve the lateral cortex.

Article Details

Issue
Vol. 39 No. 3-4 (2015): May-October
Section
Original Articles

References

1. Haynes RC, Pöll RG, Miles AW, Weston RB. Failure of femoral head fixation: a cadaveric analysis of lag screw cut-out with the gamma locking nail and AO dynamic hip screw. Injury 1997; 28: 337-341.
2. Utrilla AL, Reig JS, Muñoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 2005; 19: 229-233.
3. Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury 1995; 26: 615-618.
4. Lunsjö K, Ceder L, Stigsson L, Hauggaard A. Two-way compression along the shaft and the neck of the femur with the Medoff sliding plate: one-year follow-up of 108 intertrochanteric fractures. J Bone Joint Surg Br 1996; 78: 387-390.
5. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury 1999; 30: 327-332.
6. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991; 73: 330-334.
7. Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, et al. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system – report of early results. Bull NYU Hosp Jt Dis 2008; 66: 276-279.
8. Müller ME, Nazarian S, Koch P, Schatzker J, Heim U. The Comprehensive Classification of Fractures of the Long Bones. Berlin: Springer, 1990.
9. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures. Management and current controversies. Instr Course Lect 2004; 53: 441-454.
10. Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury 2008; 39: 932-939.
11. Rüedi TP, Murphy WM Hoffman R, Haas NP. Femur: proximal. In: AO Principles of Fracture Management (Rüedi TP, Murphy WM, eds). Stuttgart: Thieme, 2000; pp 441 – 454.
12. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br 2005; 87: 76-81.
13. Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 2001; 25: 360-362.
14. Herrera A, Domingo LJ, Calvo A, Martínez A, Cuenca J. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop 2002; 26: 365-369.
15. Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical evaluation of the Gamma nail. J Bone Joint Surg Br 1992; 74: 352-357.
16. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 2010; 92: 792-798.
17. Schipper IB, Steyerberg EW, Castelein RM, van der Heijden FH, den Hoed PT, Kerver AJ, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br 2004; 86: 86-94.
18. Sommers MB, Roth C, Hall H, Kam BC, Ehmke LW, Krieg JC. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 2004; 18: 361-368.