Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

Jae-Young Rho; Sang-Bum Kim; Youn-Moo Heo; Seong-Jin Cho; Dong-Sik Chae; Woo-Suk Lee

doi:10.12671/jkfs.2010.23.2.161

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Rho, Kim, Heo, Cho, Chae, and Lee: Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(2): 161-166.

Published online: 30 April 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.2.161

Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

Jae-Young Rho, M.D., Sang-Bum Kim, M.D., Youn-Moo Heo, M.D., Seong-Jin Cho, M.D., Dong-Sik Chae, M.D., Woo-Suk Lee, M.D.^*

Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.

^*Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to: Woo-Suk Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, 712, Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3417, Fax: 82-2-573-5393, wsleeos@kyuh.co.kr

Received 6 November 2009 Revised 25 January 2010 Accepted 16 March 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with TSP).

Materials and Methods

We retrospectively reviewed the results of 66 cases of unstable intertrochanteric fractures of the femur treated with PFNA (Group I) and CHS with TSP (Group II) which could be followed up for minimum a year. We evaluated several comparative factors such as operation time, blood loss, time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, social-function score of Jensen, and mobility score of Parker and Palmer.

Results

Group I showed shorter operation time and less blood loss with significance than group II (p<0.05), but there were no differences between the groups in the mean time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, and social-function score of Jensen (p>0.05). Two cases of cutting out of the blade through the femoral head were found in group I. One case of cutting out of the screw, one case of the breakage of the plate, and loosening of the plate were found in group II as complications.

Conclusion

We think that there were no significant differences between PFNA and CHS with TSP in view point of radiologic and clinical outcomes in unstable intertrochanteric fractures of the femur, but PFNA is less invasive device than CHS with TSP, therefore it may be useful device in elderly patients.

Keywords: Unstable intertrochanteric fracture, Proximal femoral nail antirotation, Trochanter stabilizing plate, Compression hip screw

Figures and Tables

Fig. 1

(A) Preoperative anteroposterior (AP) radiograph shows unstable intertrochanteric fracture of a 78 year-old male.

(B) Immediate postoperative AP radiograph shows internal fixation with PFNA.

(C) Nonunion of the fracture and perforation of the blade into the acetabulum has found at 12 months postoperatively.

Fig. 2

(A) Preoperative AP radiograph shows unstable comminuted intertrochanteric fracture of a 72 year-old male.

(B) Immediate postoperative AP radiograph shows internal fixation with CHS and TSP.

(C) Three months later postoperatively, radiograph shows nonunion of the fracture and breakage of the TSP (arrow).

Table 1

Demographic data of the cases

^*BMD: Bone mineral density, ^†Type: AO classification, ^‡TAD: Tip-apex distance, ^§PFNA: Proximal femoral nail antirotation, ^∥CHS: Compression hip screw, ^¶TSP: Trochanteric stabilizing plate.

Table 2

Comparative results of two groups

^*VAS: Visual analogue scale, ^†PFNA: Proximal femoral nail antirotation, ^‡CHS: Compression hip screw, ^§TSP: Trochanteric stabilizing plate.

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