Abstract
Introduction: Intertrochanteric (IT) femur fractures account for nearly 50% of all proximal femur fractures. Currently, both short and long Proximal Femoral Nail Antirotation (PFNA2) are used for the treatment of IT femur fractures. There is no consensus in the literature on which option is better for treating IT femur fractures. Aim: To assess the impact of the nail length of short PFNA2 and long PFNA2 in the surgical treatment of IT femur fractures. Materials and Methods: This randomised clinical study was conducted in the Department of Orthopaedics at Kalpana Chawla Government Medical College (KCGMC), Karnal, Haryana, India, from July 2021 to July 2023. A total of 52 IT femur fractures were included in the study. All patients were divided into two groups using simple randomisation: Group A (Short PFNA2) and Group B (Long PFNA2), consisting of 26 patients in each group. Variables such as duration of hospital stay, duration of surgery, blood loss, union time and complications were noted. All patients were followed-up at six weeks, three months and six months and functional outcomes were assessed using the MHHS. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) Statistics {version 29.0.1.0 (171)}. The Independent Student’s t-test and Chi-square test were used for continuous and categorical variables, respectively. A p-value of 0.05 or lower was considered statistically significant. Results: The mean duration of surgery for the short PFNA2 group was 60.23±2.76 minutes, while for the long PFNA2 group, it was 73.23±4.07 minutes, with a significant p-value of 0.001. The mean blood loss in the short PFNA2 group was 94±1.12 mL and in the long PFNA2 group, it was 131±21.29 mL, also with a significant p-value of 0.001. A total of 11 complications were observed in the short PFNA2 group, while only two were noted in the long PFNA2 group, which was statistically significant with a p-value of 0.013. The mean Modified Harris Hip Score (MHHS) at 6 months was 70.76±7.62 in the short PFNA2 group and 79.98±9.72 in the long PFNA2 group (p-value 0.119). Conclusion: Surgery with the short PFNA2 was associated with less blood loss and shorter operative time (resulting in less anaesthesia time), providing an advantage for older patients. Union time and functional outcomes were similar in both groups. A full-length femur X-ray should be taken to assess the anterior bowing of the femur. In such cases, the long PFNA2 should be used to protect the femur from fractures. Overall, the long PFNA2 is beneficial compared to the short PFNA2 in reducing the risks of complications in IT fractures.
Published Version
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