Comparison of PFNA and DHS for the treatment of elderly unstable intertrochanteric fractures of femur

Abstract

To compare the clinical efficacy of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) for the treatment of unstable intertrochanteric fractures in the elderly. From January 2012 to December 2015, 83 elderly patients with unstable intertrochanteric fracture of femur were divided into 45 cases treated with PFNA and 38 cases treated with DHS. In the PFNA group, there were 24 males and 21 females, aged 82 to 94(88.35±6.12) years old, duration was 1.5 to 10 (4.33±1.07) h, causes of injury involved 33 traffic accidents, 10 falls at high altitude, 2 falls; Evans-Jensen classification involved 21 cases of IIIA, 18 cases of IIIB and 6 cases of IV. In DHS group, there were 20 males and 18 females, aged 83 to 95 (88.77±5.52) years old, duration was 1 to 10 (4.37±1.05) h, 27 traffic accidents, 10 high-altitude falls and 1 fall injury, and Evans-Jensen classification involved 18 cases of IIIA, 15 cases of IIIB and 5 cases of IV. The operation time, intraoperative bleeding volume and discharged complications were observed and compared between the two groups. The Mos 36-item Short Form Health Survey (SF-36) was used to measure the quality of life before and 12 months after operation. Harris score was used to evaluate hip function 12 months after operation. The operation time, intraoperative bleeding volume and complication rate in PFNA group were significantly lower than those in DHS group(P<0.05); both groups were followed up for 12 months without falling off. The Harris score and SF-36 score at 12 months after operation in both groups were higher than those before operation(P<0.05), and the excellent and good rate in PFNA group was significantly higher than that in DHS group(P<0.05). Compared with DHS, PFNA is more simple, less traumatic, less complications, better short-term survival rate and better quality of life for elderly patients with unstable intertrochanteric fracture of femur. PFNA can be used as an optimal treatment for elderly patients with unstable intertrochanteric fracture of femur.