Our experience of managing intertrochanteric fractures in osteoporotic patients with trochanteric femoral nail (TFN) and proximal femoral anti-rotation augmentation nail (PFNA2)

Abstract

Introduction: Managing intertrochanteric fractures, especially the unstable variety has often been a challenge to the orthopaedic surgeon. However there is little data available when comparing the Trochanteric femoral nailing (TFN) and the Proximal femoral antirotation augmentation nail (PFNA2), especially in the background of an osteoporotic population.Aim: To compare the outcome of management of intertrochanteric fractures fixed with TFN and PFNA2 in the setting of osteoporosis.Materials and Methods: From June 2016 to October 2019, 40 cases of both stable and unstable intertrochanteric fractures were managed with TFN and PFNA II were followed prospectively. Postoperatively clinical and radiological outcomes assessed by tip-apex distance, union rate, Harris hip score, Singhs index. Patients were followed up for a period of six months. Result: This study was done in 40 patients with both stable and unstable intertrochanteric fractures, of which 20 of them managed with TFN and 20 managed with PFNA2. The most common mode of injury was a trivial fall followed by RTA. Fracture pattern segregated under Boyd and Griffin classification and majority of patients were found to fall under Type 2. Patients operated with PFNA2 had an average hospital stay of 15.2 days and 16 days for TFN. Patient was allowed to weight bear fully at 12.6 weeks in TFN and 12.2 weeks in PFNA2 averagely. Visible marked Union in X-rays was noted around 12-14 weeks in both TFN and PFNA2. Excellent results were found in about 90% of cases in PFNA2 group and in 85% of cases in the TFN group. The average Harris Hip Score was 84.57 and 86.56 in TFN and PFNA2 groups (p=0.54) respectively among patients with Singh’s grade 3, 2 (25%) in TFN group suffered from implant related complication whereas all 13 patients in PFNA2 group had successful outcome (p=0.04).Conclusion: In our study, PFNA2 is a technically and biomechanically more stable than TFN in the management of intertrochanteric fractures in setting of osteoporosis. Hence, we highly recommend use of the PFNA2 for the treatment of intertrochanteric fractures.