Comparison of DHS, Gamma nail and PFNA fixations for treatment of intertrochanteric femoral fractures in elderly patients

Abstract

Objective To compare the clinical effects of dynamic hip screw(DHS), Gamma interlocking intramedullary nail and proximal femoral nail antirotation(PFNA)in the treatment of intertrochanteric femoral fractures in elderly patients. Methods From January 2008 to June 2015, 103 elderly patients with intertrochanteric femoral fracture were treated with DHS(DHS group, 33 cases), Gamma nails(Gamma group, 30 cases), or PFNA(PFNA group, 40 cases). By the AO classification, there were 44 cases of type 31-A1, 30 cases of type 31-A2 and 29 cases of type 31-A3. The 3 groups were compared in terms of incision length, operation time, intraoperative blood loss, fracture healing time, postoperative weight-bearing time, Harris scoring, and incidence of postoperative complications. Results PFNA group incurred significantly shorter incision length(5. 4 ±0. 5 cm)and operation time(70. 8 ± 16. 2 min)than DHS group(12. 6 ± 2. 7 cm and 102. 6 ± 17. 4 min)and Gamma group(7. 5 ±0. 8 cm and 93. 0 ±35. 9 min)(P< 0. 05). The intraoperative blood loss in PFNA group(163. 2 ±60. 6 mL)was significantly less than in DHS group(280. 5 ±89. 8 mL)and in Gamma group(204. 9 ±62. 2 mL), and that in Gamma group was also significantly less than in DHS group(P< 0. 05). PFNA group had significantly shorter weight-bearing time(11. 0 ±0. 8 weeks), fracture healing time(13. 6 ±1. 5 weeks)and significantly higher Harris good to excellent rate(92. 5%)than DHS group(13. 3 ±1. 0 weeks, 15. 8 ±1. 2 weeks and 84. 8%)and Gamma group(12. 5 ±1. 3 weeks, 14. 2 ±1. 0 weeks and 86. 1%)(P< 0. 05). The incidence of postoperative complications in DHS group(21. 2%)was significantly higher than in Gamma group(10. 0%)and in PFNA group(7. 5%)(P<0. 05). Conclusions DHS, Gamma nail and PFNA are effective means for the treatment of intertrochanteric femoral fractures in the elderly. Intramedullary fixation, especially by PFNA, shows superiority in the clinical outcomes. Key words: Hip fractures; Fracture fixation, internal; Bone nails; Aged