A Comparative study of Functional outcomes in PFN versus PFNA for Fixation of Unstable Intertrochanteric Fracture

Background: Unstable intertrochanteric fractures poses challenges in terms of obtaining stable fixation and good postoperative outcomes. There is a paucity of clinical data comparing the commonly used Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) implants, especially in relation to osteoporosis. Objective: To assess comparative performance of PFN and PFNA fixation in the treatment of unstable femur intertrochanteric fractures. Methods: This study was conducted from November 2021 to October 2023 at Department of Orthopedics, in a tertiary care center located in northern India. Patients presenting with unstable intertrochanteric were included and treated with either PFN or PFNA. Boyd and Griffin classification type 2, 3 and 4 were included. A proximal femoral nail was used to treat all fractures. At the follow-ups, all patients were evaluated using the Modified Harris Hip Score. Patients were followed up for a minimum of 6 months and any complications noted. Comparison of functional outcomes was done using the Harris Hip Score. Statistical analysis was done using the unpaired t-test/Mann-Whitney U test and Chi-square test/Fisher’s-exact test. A p-value of < 0.05 was considered significant. Results: Every follow-up period included a Harris hip score assessment. At 3 months, the average score of PFN was 71.9 (range 66-81) and at 6 months it was 77.86 (range 72-90). For PFNA, at 3 months the average score was 74.87 (range 66-81) and at 6 months, it was 89.3 (range 76-94). The improvement was seen well in PFNA group which is statistically significant (p-0.023). The most prevalent fracture was a type 2 fracture. Conclusion: The results showed PFNA has better rotation stability with single screw and better functional outcome in treating unstable intertrochanteric fractures when compared to PFN.