Functional and radiological outcome in unstable intertrochanteric femur fractures – PFN versus PFNA2 and its implication in less educated and low socioeconomic patients

Introduction. Intertrochanteric (IT) femur fracture accounts for nearly 50% of all proximal femur fractures, and low velocity trauma is a major cause of IT fractures in the elderly population. Surgical treatment is essential for obtaining a reduction as well as for the early rehabilitation of the patient. In the proximal femoral nail (PFN), two screws are used for fracture fixation. The proximal femoral nail antirotation II (PFNA2) design increases the bone-implant interface and effectively compacts the cancellous bone, providing excellent fixation stability. Limited studies have shown that this implantmay also present complications similar to those observed with previous implants, including issues related to cut-through, and back-out. Materials and methods. A total of 54 unstable IT fractures were included in the study. Assessment of the compression screw position was done using the Cleveland index. The final functional outcome was assessed by Modified Harris Hip Score (MHHS) at 6 months. Results. The neck-shaft angle was assessed between the two PFN groups and the PFNA2 group. The p-value was found to be 0.79, indicating statistical insignificance. Assessment of the compression screw position was done using the Cleveland index. The p-value was found to be 0.34, which was statistically insignificant. The MHHS at final follow-up (6 months) was better in the PFNA2 group. The p-value was 0.0065, which was statistically significant. Complications were compared between the groups. The p-value was 0.034, which is statistically significant. By demonstrating the complications in bone models, complications observed in the PFN can be easily demonstrated to the patient and their attendant, so that after surgery with PFNA2, complications will be less, and the patient will have a choice for a better implant. Conclusions. PFNA2 is a preferable implant for unstable IT femur fracture, as it reduces operative time and blood loss. It also offers superior functional and radiological outcomes compared to PFN. This approach has dual advantages of saving the patient money, as it reduces the reoperation rate, and secondly, it avoids further surgical trauma in elderly people.