Comparative study of functional outcome of inter-trochanteric fractures in adult population treated with modified first generation proximal femoral nail versus second generation proximal femoral nail- PFN-A2

Background: Intertrochanteric fractures are fairly prevalent in elderly, owing to osteoporosis. High velocity trauma is a common cause in younger age groups. Surgical fixation is the choice of treatment. Closed reduction being minimally invasive has lower infection rates and higher union rate. Providing early mobility lowers morbidity. Over time, there have been multiple changes in the implant design. Two screws in femoral head are used in the first generation PFN, compared to a single helical bolt in the subsequent modification i.e. PFNA2. Methods: Prospective and comparative study was undertaken, from January 2023 to June 2024, including 52 adults (17 males and 35 females) of either sex, with intertrochanteric fracture femur. 26 patients underwent first generation PFN (group A) and 26 underwent PFNA2 (group B). Clinico-radiological evaluation was done at 6 weeks, 3-, 6- and 12-months following surgery. Functional evaluation was based on the mean Harris hip score (HHS). Post-operative pain based on VAS, early mobilization and complications were taken into consideration. Statistics was analysed with Statistical Package for The Social Sciences (IBM SPSS version 22). Results: There was 100% union rate. The average date of mobilization in group A patient was 1.9±0.8 days and in group B was 2.2±0.7 days. Group A has a statistically significant higher VAS score than group B at 24 hours post-surgery. Weight bearing as tolerated was started on day 1 post surgery in all patients. The mean HHS was significantly higher in group B (71.5±3.8) at 6 weeks follow-up, which on subsequent follow-ups was statistically insignificantly between the two groups. None of the patients had implant failure of any form. Conclusions: The final outcome was statistically insignificant. There was negligible difference between the first generation PFN and PFNA2 in terms of post-operative stability and fracture union. Hence, both PFN and PFNA2 are equally suitable devices for fixation of inter-trochanteric fracture.