Screw versus helical proximal femoral nail in the treatment of unstable trochanteric fractures in the elderly.

PURPOSE: Comparison of clinical, radiological and functional outcomes of screw proximal femoral nail (PFN) and helical PFN in management of unstable trochanteric fractures.

METHODS

This prospective randomised comparative study included 60 patients with closed unstable intertrochanteric fractures (AO classification-A2.2-A2.3 & A3.1-A3.3). Patients were randomised to 2 treatment groups using simple random sampling method utilizing computer based randomisation. Screw PFN and helical PFN were used for internal fixation with 30 patients in each group.

RESULTS

Both groups were similar in respect of age, gender, fracture classification, quality of fracture reduction, duration of hospitalization, post-operative complications, residual/late deformity as well as functional assessment. However, mean duration of surgery was significantly lower (23.1%) in helical PFN group as compared to screw PFN group (43.32 ± 8.20 min vs. 35.20 ± 6.03 min, p < 0.001). Furthermore, mean blood loss was not significant in either of the study groups but it was significantly lesser (30.1%) in helical PFN group as compared to screw PFN group (77.80 ± 17.39 ml vs. 59.80 ± 14.96 ml, p < 0.001). Also, mean number of images taken was significantly lower (58.7%) in helical PFN group as compared to screw PFN group (29.52 ± 4.85 no vs. 18.60 ± 3.12 no, t = 9.47; p < 0.001).

CONCLUSION

Both screw PFN and helical PFN are equally effective implants in internal fixation of unstable trochanteric fractures with no statistically significant difference (p > 0.05) in any of the outcome measures. However, helical PFN group fared marginally better in terms of operative time, blood loss and imaging required.