CLINICAL, FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF PROXIMAL FEMUR NAIL (PFN) IN COMPARISON WITH PROXIMAL FEMUR NAIL ANTIROTATION FOR ASIANS (PFNA2) IN THE TREATMENT OF INTERTROCHANTERIC FEMUR FRACTURE

Introduction:Intertrochanteric fractures management in elderly pose a serious challenge. The implants have evolved from extramedullary implants like dynamic hip screw to the intramedullary types of PFNA2 nail. Intramedullary implants have proven advantage over their counterpart in terms of stable anatomical fixation and better functional outcome.The main goal of fixation is early mobilization of patient in order to prevent complications of prolonged bed ridden status. Material And Methods:A prospective, randomized, interventional, comparative study of 40 patients (PFN-20, PFN A2-20) who presented to us between 27 July 2022 to 27 January 2024 after applying inclusion and exclusion criteria.The details of the patients including gender, age, side of fracture, type of fracture, blood loss, time of union, operating time and complications were recorded. Patients were assessed clinically, functionally and radiographically at 6, 12, 24 weeks,1 year postoperatively.Harris Hip Score was used to assess functional outcome. Results:In this study, the mean ages of the PFN- 46.95 years , PFN A2 -53.45 years. Mean operative time for PFN was 111 minutes & PFNA2 had 76.75 minutes. The mean amount of blood loss for PFN is 112 ml & for PFNA2 is 98.75 ml. Mean radiological union time was 19.50 weeks for PFN & 17.05 weeks for PFNA2. Mean Harris hip score is 84 in PFN & 88 in PFNA2. The complications In the PFN A2 group were 1 experienced abduction lurch, 1 The complications In the PFN A2 group were 1 (5.0%) abduction lurch, 1 (5.0%) knee stiffness, 1 (5.0%) non-union, and 2 (10.0%) superficial infection. In the PFN group 2 (10.0%) abduction lurch, 2 (10.0%) knee stiffness, 2 (10.0%) non-union, 3 (15.0%) superficial infection, and 1 (5.0%) the Z effect. Concussion:From the study we concluded that the PFNA2 reduces the surgery time, blood loss and time of union as compared to PFN. As the union rate is more with PFNA2, the functional outcome is significantly better with Improved Harris hip score in PFNA2 than PFN. Implant related late complication is more with PFN which was markedly reduced with PFNA2.