Treatment options for unstable trochanteric fractures: Screw or helical proximal femoral nail

Abstract

PurposeTo compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. MethodsThe study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2 & 31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2 & A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk independently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN. ResultsBoth groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening >1 cm but <2 cm, while in helical PFN group 1 patient had superficial wound infection. ConclusionBoth screw and helical PFN are very effective implants in osteoporotic and unstable trochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.