Comparison of Clinical and Functional Outcome of Intertrochanteric Femur Fractures Treated Using Proximal Femoral Nail and Proximal Femoral Nail Antirotation-2 in Patients with Osteoporosis

Abstract Background: Intertrochanteric femur fractures are commonly treated with intramedullary nailing. Different designs of intramedullary nails are available. The conventional Proximal Femoral Nail (PFN) has good results while also being associated with complications. Proximal Femoral Nail Anti-rotation 2 is a newer nail design introduced for Asian population. This study aims to compare clinical and functional outcome of intertrochanteric femur fractures treated with conventional PFN and PFNA2 in patients with osteoporosis. Materials and Methods: Patients presenting with Intertrochanteric fractures, less than 2 weeks old, with Singh’s Index </= 3 were included in the study. Patients were allotted 2 different groups based on the implant used for treatment (PFN group and PFNA2 group). Quality of reduction was assessed using neck shaft angle, tip apex distance and Cleveland index in postoperative radiographs. The duration of surgery, number of fluoroscopy images taken, intraoperative blood loss and duration of hospital stay were noted. Patients were followed-up for 6 months. Functional outcome was assessed using modified Harris hip score. The data was analysed using student’s unpaired t test/Mann– Whitney U test and Chi-square test/Fisher’s exact test. A p value less than 0.05 was considered significant. Result: 20 patients with intertrochanteric femur fracture were treated with PFN and 19 patients with intertrochanteric femur fracture were treated with PFNA2. 4 patients in PFN group and 1 patient in PFNA2 group had neck shaft angle difference of >100 between operated side and uninjured side. 6 patients in PFN group while 4 patients in PFNA2 group had tip apex distance of >25mm. The average Harris hip score was 79.00 in PFN group and 86.63 in PFNA2 group. 6 complications were seen in PFN group and 3 in PFNA2 group. Conclusion: Both the studies achieved similar functional outcome. Similar functional outcome can be achieved with PFNA2 while using less intraoperative resources. Good functional outcome is possible when the radiological parameters are restored, i.e., neck-shaft angle difference < 50, tad <25 mm and Cleveland index in center-center position. No significant difference in terms of overall complications between the two groups. PFNA2 achieved better results in terms of perioperative morbidity.