Proximal femoral nail anti-rotation versus dynamic hip screw in the repair of intertrochanteric fracture in the elderly

Xu Hou-gao

doi:10.3969/j.issn.2095-4344.2014.35.007

Abstract：BACKGROUND:For younger patients with intertrochanteric fractures, many fixation methods can provide an effective and robust fixation, but for elderly patients with osteoporosis intertrochanteric fracture, there remains debate for which fixation method is optimum. OBJECTIVE:To compare the clinical outcomes of proximal femoral nail anti-rotation and dynamic hip screw in the repair of intertrochanteric fracture. METHODS:Clinical data of patients with intertrochanteric fracture treated by proximal femoral nail anti-rotation or dynamic hip screw at the Suzhou Xiangcheng People’s Hospital from January 2010 to January 2013 were selected. In accordance with the inclusion criteria, 140 patients (146 hips) were included, containing 70 patients in the proximal femoral nail anti-rotation group (74 hips) and 70 patients in the dynamic hip screw group (72 hips). No significant difference in preoperative general data was detected in patients of both groups (P>0.05), showing a comparability. Operative time, intra-operative blood loss, the average length of hospital stay, postoperative ambulation time, perioperative hemoglobin loss amount, postoperative complications, healing time, and Harris score were compared and evaluated in both groups. RESULTS AND CONCLUSION:140 patients were fol owed up for 8-16 months. The incision was stage I healing. Compared with dynamic hip screw group, operative time, intra-operative blood loss, the average length of hospital stay, and postoperative ambulation time were better in the proximal femoral nail anti-rotation group (P<0.05). However, no significant differences in perioperative hemoglobin loss amount, healing time, and postoperative Harris score were visible in the both groups (P>0.05). These findings suggested that proximal femoral nail anti-rotation and dynamic hip screw in the repair of intertrochanteric fracture could obtain satisfactory clinical outcomes, but proximal femoral nail anti-rotation has some advantages such as short operative time, less blood loss, short mean hospital stay, early postoperative ambulation time and less postoperative complications.