Hip Pelvis.  2016 Dec;28(4):232-242. 10.5371/hp.2016.28.4.232.

Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation

• Cho HM
• Lee K

• KMID: 2364701
• DOI: http://doi.org/10.5371/hp.2016.28.4.232

Abstract

PURPOSE
We aimed to evaluate and compare the clinical and functional outcomes of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) treatment of AO type 1 intertrochanteric fractures in elderly patients.
MATERIALS AND METHODS
We retrospectively reviewed 194 consecutive patients with type A1 intertrochanteric femoral fractures who were treated with DHS (n=113) or PFNA (n=81). We evaluated operation time, intraoperative blood loss, and functional outcomes, walking ability, and the Barthel activities index. Fracture union, sliding of hip screw, proximal femur shortening, and presence of complications were assessed radiologically at relevant follow-up intervals.
RESULTS
The mean operation time and blood loss were significantly lower for the PFNA group, but walking ability and Barthel index decreased to a similar extent for both groups. However, patients in the DHS group complained of significantly more pain (P=0.049). Although there were no significant differences between the two groups with respect to the time until fracture union was achieved, patients in the DHS group exhibited a higher extent of proximal femoral shortening and sliding of the hip screw. Differences about hip screw sliding and proximal femur shortening within each subgroup were not significant.
CONCLUSION
Compared to DHS treatment, PFNA treatment of type A1 intertrochanteric fractures is associated with reduced blood loss, shorter operation time, and less severe pain after surgery. Additionally, sliding of the hip screw and proximal femur shortening are expected to occur more frequently after DHS.

Keyword

Femur; Intertrochanteric fractures; Fracture fixation; Internal

MeSH Terms

Aged*
Femoral Fractures*
Femur
Follow-Up Studies
Fracture Fixation
Hip Fractures
Hip*
Humans
Retrospective Studies
Walking

Figure

• 

  Fig. 1 Radiographs of a 77-year-old woman with left-sided type A1 intertrochanteric fracture treated with dynamic hip screws (DHS). (A) Preoperative anteroposterior radiographs suggesting type A1 intertrochanteric fracture. (B) Immediate postoperative radiographs showing reduction of fracture with DHS, and circular wiring fixation for the lateral wall fracture. (C) Proximal migration of greater trochanteric fragment at three months postoperatively. (D) Excessive sliding and shortening of proximal fracture fragment at 5 months postoperatively. (E) Antero-posterior radiographs showing complete union at 12 months postoperatively.

• 

  Fig. 2 Radiographs of a 77-year-old man with left-sided type A1 intertrochanteric fracture treated with proximal femoral nail antirotation (PFNA) implant. (A) Preoperative anteroposterior radiographs suggesting type A1 intertrochanteric fracture. (B) Immediate postoperative radiographs showing suitable reduction of fracture with PFNA. (C) Cut-through of helical blade at four months postoperatively, mandating reoperation. (D) Immediate postoperative radiographs showing replacement of helical blade with an autogenous bone graft. (E) Cut-through of helical blade at three months after reoperation. (F) Bipolar hemiarthroplasty was performed.

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