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
ARTICLE HIGHLIGHTS
Research background

There are few studies comparing clinical and radiologic outcomes between proximal femoral nail antirotation (PFNA) and previous-generation proximal femoral nail (PFN) in elderly patients with pertrochanteric femoral fracture (PFF).

Research motivation

We evaluated the clinical and radiographic outcomes after fixation with PFN and PFNA for PFF in elderly patients.

Research objectives

From January 2003 to December 2009, seventy-three patients underwent fixation with PFN (PFN group), whereas 85 patients were fixed with PFNA (PFNA group). The mean duration of radiographic follow-up was 2.4 years (range, 1-7 years). The PFN group was composed of 31 men and 42 women with an average age of 76.6 ± 7.3 years. The PFNA group consisted of 37 men and 48 women with an average age of 74.9 ± 7.2 years.

Research methods

We evaluated each patient’s medical history and converted it to a Charlson Comorbidity Index score and femoral bone mineral density. There was no difference in demographics between the two groups (P > 0.05). Clinical outcome was measured in terms of operation time, postoperative function according to Salvati and Wilson’s hip function rating system and mortality rate within one year. Radiographic evaluation included the reduction state after the operation, the Cleveland Index[19], 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.

Research results

The proportion of patients with excellent or good postoperative function was significantly higher in the PFNA group compared to the PFN group (94.1% and 83.6%, respectively, P = 0.033). Differences in operation time and mortality within one year were not significantly different between the two groups (P > 0.05). Sliding distance was 6.1 mm (range, 0-23.6 mm) in the PFN group, and was 3.2 mm (range, 0-18.4 mm) in the PFNA group at final follow-up (P = 0.036). There was no difference between the two groups in terms of reduction state, Cleveland Index, TAD, union rate and time to union. Screw cutout was demonstrated in eight (11.0%) patients in the PFN group and in two (2.4%) patients in the PFNA group (P = 0.027).

Research conclusions

PFNA using a helical blade demonstrated better outcomes in terms of clinical score, sliding distance and cutout rate following treatment of PFF in elderly patients than PFN.

Research perspectives

A randomized control study with longer-term follow-up may be necessary to draw a definitive conclusion.