Proximal femoral nail antirotation versus Gamma nail in treatment of femoral trochanteric fractures

Abstract

Background Two osteosynthesis methods, proximal femoral nail antirotation (PFNA) and gamma nail (GN), were used in the management of femoral trochanteric fractures to prevent the complications of long-term confinement to bed for the elderly. This study evaluated the clinical results of PFNA and GN in treatment of femoral trochanteric fractures. Methods This is a retrospective study of patients with femoral trochanteric fractures who had procedures with GN or PFNA from January, 2005 to December, 2008. Two-hundred sixty-three patients initially fulfilled the study criteria, and 55 patients were lost to follow-up. Of the remaining 208 patients available for analysis, 96 had GN (46 men and 50 women) and 112 had PFNA (52 men and 60 women). Clinical and radiographic outcomes were measured and compared between the two groups. Results The surgery was successfully performed in all patients, and no intraoperative deaths occurred. The operating time for GN was longer than PFNA. All fractures in the PFNA group and 82 cases in the GN group united between 3 and 4 months, and 14 patients with GN had delayed union (5–9 months). The Parker's score evaluations were significantly in favor of PFNA (P<0.05). No significant differences were noted in the fracture reduction quality, but significant differences were noted in the screw position between the two groups (P<0.05). Conclusions PFNA had the advantages of antirotation and antivarus collapse compared with GN, which led to the good screw position, faster union and better functional results.