Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2020; 11(11): 483-491
Published online Nov 18, 2020. doi: 10.5312/wjo.v11.i11.483
Does proximal femoral nail antirotation achieve better outcome than previous-generation proximal femoral nail?
Seung-Hoon Baek, Seunggil Baek, Heejae Won, Jee-Wook Yoon, Chul-Hee Jung, Shin-Yoon Kim
Seung-Hoon Baek, Heejae Won, Jee-Wook Yoon, Chul-Hee Jung, Shin-Yoon Kim, Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
Seung-Hoon Baek, Shin-Yoon Kim, Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
Seunggil Baek, Department of Orthopedic Surgery, Goodssen Hospital, Daegu 42010, South Korea
Author contributions: Yoon JW and Jung CH collected the demographic data; Baek SH and Baek S contributed to the data interpretation; Baek SH, Baek S and Won H contributed to the manuscript preparation; Baek SH, Won H and Kim SY edited the manuscript; all authors gave final approval of the version to be submitted and any revised versions.
Institutional review board statement: The study was reviewed and approved by the Kyungpook National University Hospital Institutional Review Board.
Informed consent statement: This retrospective study was approved by the Institutional Review Board in our institution which waived informed consents.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shin-Yoon Kim, MD, PhD, Professor, Department of Orthopedic Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-Gu, Daegu 41944, South Korea. syukim@knu.ac.kr
Received: June 17, 2020
Peer-review started: June 17, 2020
First decision: July 21, 2020
Revised: July 29, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: November 18, 2020
Processing time: 150 Days and 9.4 Hours
Abstract
BACKGROUND

There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) for pertrochanteric femoral fracture (PFF) in elderly patients.

AIM

To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.

METHODS

One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included. Seventy-three patients underwent fixation with PFN, whereas 85 were fixed with PFNA. The mean follow-up was 2.4 years (range, 1-7 years). Clinical outcome was measured in terms of operation time, postoperative function at each follow-up visit, and mortality within one year. Radiographic evaluation included reduction quality after surgery, Cleveland Index, tip-apex distance (TAD), union rate, time to union, and sliding distance of the screw or blade. Complications including nonunion, screw cutout, infection, osteonecrosis of the femoral head, and implant breakage were also investigated.

RESULTS

Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN (P = 0.033). Radiologically, the sliding difference was greater in PFN than in PFNA patients (6.1 and 3.2 mm, respectively, P = 0.036). The rate of screw cutout was higher in the PFN group; eight for PFN (11.0%) and two for PFNA patients (2.4%, P = 0.027). There were no differences between the two groups in terms of operation time, mortality rate at one year after the operation, adequacy of reduction, Cleveland Index, TAD, union rate, time to union, nonunion, infection, osteonecrosis, or implant breakage.

CONCLUSION

Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.

Keywords: Pertrochanteric fracture, Proximal femoral nail, Proximal femoral nail antirotation, Sliding distance, Cutout, Outcome

Core Tip: There are few studies comparing the clinical outcomes and radiographic results in elderly patients with pertrochanteric femoral fracture (PFF) receiving proximal femoral nail antirotation (PFNA) and those receiving the previous-generation proximal femoral nail. PFNA using a helical blade demonstrated better clinical and radiographic outcomes in terms of clinical score, sliding distance and cutout rate in elderly patients with PFF.