EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND DYNAMIC HIP SCREW FOR INTERTROCHANTERIC FRACTURES IN THE ELDERLY PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Guangyin.

Department of Orthopedics, Dongfang Hospital of Yangzhou, Yangzhou Jiangsu, 225000, P.R.China.;

Corresponding author：

Keywords：

Intertrochanteric fracture; Dynamic hip screw; Proximal femoral nail antirotation; Internal fixation; Elderly patient

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Objective To compare the effectiveness of the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of elderly patients with intertrochanteric fractures. Methods Between May 2007 and May 2010, 63 elderly patients with intertrochanteric fractures were treated, and fractures were fixed with PFNA in 31 patients (PFNA group) and with DHS in 32 patients (DHS group). There was no significant difference in gender, age, injury cause, disease duration, and fracture type between 2 groups (P gt; 0.05). Results All incisions healed by first intention. The incision length, operation time, and blood loss in PFNA group were significantly less than those in DHS group (P lt; 0.05). The average
follow-up time was 13.6 months in PFNA group and was 13.8 months in DHS group. The fracture heal ing time was (11.80 ± 1.32) weeks in PFNA group and was (12.21 ± 1.26) weeks in DHS group, showing no significant difference (t=1.23, P=0.29). The complication rate was 0 in PFNA group and was 12.5% (4/32) in DHS group, showing no significant difference (P=0.06). After 1 year, Harris hip score of PFNA group (86.55 ± 10.32) was higher than that of DHS group (80.36 ±11.18) (t=2.28, P=0.03). Conclusion There are two surgical methods to treat intertrochanteric fractures in the elderly patient: PFNA and DHS, and each has advantages; for unstable intertrochanteric fractures, PFNA treatment is the first choice.

Citation： SHEN Guangyin.. EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND DYNAMIC HIP SCREW FOR INTERTROCHANTERIC FRACTURES IN THE ELDERLY PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(6): 671-674. doi: Copy

1.	Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in United States. JAMA, 2009, 302(14): 1573-1579.
2.	Hsueh KK, Fang CK, Chen CM, et al. Risk factors in cutout of sliding hip screw in intertrochanteric farctures: an evaluation of 937 patients. Int Orthop, 2010, 34(8): 1273-1276.
3.	Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand, 1980, 51(5): 803-810.
4.	Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
5.	Güven M, Yavuz U, Kadioğlu B, et al. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthop Traumatol Surg Res, 2010, 96(1): 21-27.
6.	陈柯, 刘立云. 动力髋螺钉和防旋股骨近端髓内钉治疗老年骨质疏松性股骨转子间骨折的早期疗效评价. 中国矫形外科杂志, 2011, 19(10): 801-803.
7.	方大标, 王秋根, 张秋林, 等. 医源性因素对DHS治疗髋部骨折疗效的影响. 中华创伤骨科杂志, 2004, 6(5): 525-528.
8.	张经纬, 蒋垚, 张先龙, 等. 股骨转子间骨折不同手术方法比较. 中华骨科杂志, 2005, 25(1): 7-11.
9.	Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
10.	李必奎, 陈周兵, 徐富生. 股骨近端锁定钢板治疗股骨转子间骨折. 中国修复重建外科杂志, 2011, 25(10): 1273-1275.
11.	Wong TC, Chiu Y, Tsang WL, et al. A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip scvew fixation of intertrochanteric fractures. Injury, 2009, 40(4): 422-427.
12.	Xu YZ, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparion of the proximal femoral nail antirotation and gamma nail. Orthopedics, 2010, 33(7): 473.
13.	Takigami I, Matsumoto K, Ohara A, 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(4): 276-279.
14.	Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new desigen for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4): 428-432.
15.	Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip hip fractures: a biomechanical evaluation. Injury, 2006, 37(10): 984-989.
16.	秦晖, 安智全. InterTan治疗股骨粗隆间骨折的疗效评估. 中国修复重建外科杂志, 2010, 24(12): 1424-1427.
17.	Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
18.	Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma, 2005, 19(9): 656-660.

1. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in United States. JAMA, 2009, 302(14): 1573-1579.
2. Hsueh KK, Fang CK, Chen CM, et al. Risk factors in cutout of sliding hip screw in intertrochanteric farctures: an evaluation of 937 patients. Int Orthop, 2010, 34(8): 1273-1276.
3. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand, 1980, 51(5): 803-810.
4. Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
5. Güven M, Yavuz U, Kadioğlu B, et al. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthop Traumatol Surg Res, 2010, 96(1): 21-27.
6. 陈柯, 刘立云. 动力髋螺钉和防旋股骨近端髓内钉治疗老年骨质疏松性股骨转子间骨折的早期疗效评价. 中国矫形外科杂志, 2011, 19(10): 801-803.
7. 方大标, 王秋根, 张秋林, 等. 医源性因素对DHS治疗髋部骨折疗效的影响. 中华创伤骨科杂志, 2004, 6(5): 525-528.
8. 张经纬, 蒋垚, 张先龙, 等. 股骨转子间骨折不同手术方法比较. 中华骨科杂志, 2005, 25(1): 7-11.
9. Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
10. 李必奎, 陈周兵, 徐富生. 股骨近端锁定钢板治疗股骨转子间骨折. 中国修复重建外科杂志, 2011, 25(10): 1273-1275.
11. Wong TC, Chiu Y, Tsang WL, et al. A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip scvew fixation of intertrochanteric fractures. Injury, 2009, 40(4): 422-427.
12. Xu YZ, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparion of the proximal femoral nail antirotation and gamma nail. Orthopedics, 2010, 33(7): 473.
13. Takigami I, Matsumoto K, Ohara A, 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(4): 276-279.
14. Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new desigen for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4): 428-432.
15. Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip hip fractures: a biomechanical evaluation. Injury, 2006, 37(10): 984-989.
16. 秦晖, 安智全. InterTan治疗股骨粗隆间骨折的疗效评估. 中国修复重建外科杂志, 2010, 24(12): 1424-1427.
17. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
18. Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma, 2005, 19(9): 656-660.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND DYNAMIC HIP SCREW FOR INTERTROCHANTERIC FRACTURES IN THE ELDERLY PATIENTS

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