Clinical outcomes between long and short proximal femoral nail antirotation (PFNA-II) devices in the management of extracapsular hip fractures: a retrospective cohort study

Abstract

Background: Long and short intramedullary nails have been used in the treatment of extracapsular hip fractures. Long nails without distal interlocking screws may provide additional stability while avoiding complications associated with screw insertion, but these have not been well evaluated. This study aims to compare the outcomes of locked short Proximal Femoral Nail Antirotation-II (PFNA-II, Synthes Holding AG, Solothurn, Switzerland) nails and unlocked long PFNA-II nails for the treatment of extracapsular hip fractures. Methods: Ninety-one patients at our level I trauma center received these implants (61 long, 30 short). This retrospective cohort study evaluated the days to ambulation, length of stay (LOS), Radiographic Union Score for Hip (RUSH), and complication rate. Results: Days to ambulation (4.8±5.1 vs. 5.6±8.6, P=0.29) and LOS (12.6±8.3 vs. 10.4±8.1, P=0.12) were similar between both groups. Although both groups demonstrated significant improvement in RUSH scores between 1 and 3 mo, there were no significant differences between both groups (16.4±2.6 vs. 17.4±2.9, P=0.10; 25.6±3.6 vs. 24.7±3.1, P=0.24). There were more postoperative complications in the long group (29.5% vs. 13.3%), including one patient with malunion in each group. Conclusions: The purported extra stability of the unlocked, long PFNA-II device in extracapsular hip fractures has not been demonstrated in this study. Hence, we recommend the short PFNA-II device in extracapsular hip fractures due to its superior cost-benefit advantage. Level of Evidence: Level IV.