Analysis of elderly patients with inter-trochanteric fracture and failure of postoperative internal fixation

ObjectiveThis study aims to compare the efficacy and safety of Proximal Femoral Nail Anti-Rotation (PFNA) versus Dynamic Hip Screw (DHS) in the treatment of intertrochanteric fractures (IF) in elderly patients. We specifically evaluate perioperative indicators, postoperative hip function, and the rate of internal fixation failure.Methods300 elderly IF patients treated in our hospital from July 2018 to May 2022 were divided into the PFNA group (n = 150), control group (n = 150), PFNA group treated with PFNA, and control group treated with mobility hip screw (DHS). Perioperative bleeding, operation time, postoperative time and hospital time were observed in the two groups: fracture reduction, hip function at 1 and 6 months after surgery, and failure of internal fixation. Observe the postoperative internal fixation failure in the PFNA group.ResultsThe intraoperative blood loss, operation time, first postoperative time and hospital time in the PFNA group were less than in the control group (P < 0.05). One month after surgery, the Harris score of the PFNA group was less than that of the control group (P < 0.05); the Harris score was not different at 6 months (P > 0.05). The excellent rate of fracture reduction in the PFNA group was greater than that in the control group (P < 0.05). The failure rate of internal fixation in the PFNA group was less than that in the control group (P < 0.05). By univariate analysis, Sing Index classification, Evans classification, 25 min and underlying disease were risk factors for postoperative internal fixation failure in PFNA patients (P < 0.05). After multivariate Logistic regression analysis, Sing Index grade, Evans classification, and tip distance 25min were independent risk factors for postoperative internal fixation failure in PFNA patients (P < 0.05).ConclusionThe treatment of elderly IF patients with PFNA has the advantages of small trauma, good fracture reduction, firm internal fixation, low failure rate of internal fixation, and quick postoperative recovery. Sing index classification, Evans classification, and 25min tip distance mainly caused internal fixation failure in patients with PFNA.