Abstract:Objective To compare the outcome of proximal femoral nail anti-rotation (PFNA) versus anatomical locking plate (ALP) in treatment of unstable intertrochanteric fracture. Methods The study included 89 patients who had received PFNA fixation (PFNA group, n=45) or ALP fixation (ALP group, n=44) for unstable intertrochanteric fracture between February 2008 and September 2009. Operation time, amount of bleeding, drainage volume, postoperative complications, fracture healing time and hip joint score after fracture healing were compared between two groups. Results Mean operation time in PFNA group was obviously shorter than that in ALP group (61.4 minutes vs 114.8 minutes, P<0.01). Mean amount of bleeding and drainage volume were significantly lower in PFNA group than in ALP group (119.3 ml vs 136.8 ml, P<0.01; 74.9 ml vs 80.3 ml, P<0.01). While, PFNA group was not significantly different from ALP group with regard to average fracture healing time and Harris hip joint score after fracture healing (4 months vs 4.1 months, P>0.05; 91.2 points vs 89.8 points, P>0.05). Two patients had poor fracture reduction in PFNA group, but all patients had good fracture reduction in ALP group. No obvious adverse postoperative complications occurred in PFNA group, but one patient had fracture nonunion in ALP group. Conclusions PFNA and ALP fixation of unstable intertrochanteric fracture present insignificant differences in fracture healing time, postoperative complications and hip joint function after fracture healing. Whereas, PFNA is more suitable for the elder patients on account of shorter operation time and less intraoperative bleeding.
YANG Pei-yan,LI Yao-feng,YOU Yuan-zhang. Comparison of proximal femoral nail anti-rotation and anatomical locking plate in fixation of unstable intertrochanteric fracture[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(4): 330-333.
[1]Barton TM, Gleeson R, Topliss C, et al. 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(4):792-798.
[2]Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4):428-432.
[3]Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31(2):190-203.
[4]Mullerler ME, Nazarian S, Koch P. The Comprehensive classification of fractures of the long bones. 1st ed. New York: Springer Verlag, 1990:118-121.
[5]Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury, 2008, 39(8):932-939.
[6]Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury, 2006, 37(10):984-989.