Clinical investigation on the impact of closed reduction and PFNA for intertrochanteric femoral fractures on stability and torsional resistance

ZHOU Wujie; JIN Yingying; CHEN Zuoxi; XU Bing

doi:10.13276/j.issn.2097-1656.2025.03.016

Abstract：Objective To investigate the impact of closed reduction and proximal femoral nail antirotation(PFNA)on the stability and torsional resistance of intertrochanteric femoral fractures.Methods A total of 90 patients with intertrochanteric femoral fractures admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Zhejiang Chinese Medical University from September 2021 to February 2023 were selected as the study objects.They were divided into two groups according to random number table method.The control group was given dynamic hip screw fixation,and the observation group was given closed reduction and PFNA fixation.The study compared the surgical outcomes of the two groups,including fracture alignment,hip joint mobility,and postoperative complication rates six months after surgery;pain levels at 1,3,and 7 d after surgery[Numerical Rating Scale(NRS)];and motor function and activities of daily living before and 6 months after surgery[hip joint function(Harris Hip Score),Hospital for Special Surgery Knee Score(HSS),and activities of daily living(Barthel Index)].Additionally,three-dimensional finite element analysis was employed to measure displacement under vertical loads of 200,400,and 600 N,and torque resistance at 1 °,3 °,and 5 ° of torsion six months after surgery.Results The observation group demonstrated reduced hospital stay,operative duration,and time to fracture consolidation compared to the control group,with less intraoperative blood loss(P＜0.01).NRS scores of the observation group were lower than those of the control group at 1,3,and 7 d after surgery at rest and during exercise(P＜0.05).No significant difference in fracture alignment was observed between the two groups at six months after surgery(P＞0.05).Both groups experienced an increase in hip joint mobility,with the observation group demonstrating a more significant enhancement compared to the control group at six months after surgery(P＜0.05).Harris Hip Score,HSS and Barthel Index in both groups were increased,and the observation group achieved higher scores than the control group(P＜0.05).The observation group exhibited less displacement under vertical loads of 200,400 and 600 N and greater torque resistance at 1°,3°,and 5° of torsion compared to the control group(P＜0.05).The total incidence of complications,including implant loosening,displacement,and rotational instability,was lower in the observation group at six months after surgery(P＜0.05).Conclusion Closed reduction and PFNA fixation is an effective treatment for intertrochanteric femoral fractures,which can promote postoperative recovery,improve joint function,enhance stability and torsional resistance,and reduce incidence of postoperative complications.