Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study

Shenghu Zhou, Jun Liu, Ping Zhen, Weiwei Shen, Yanfeng Chang, Haoqiang Zhang, Qingsheng Zhu, Xusheng Li, Shenghu Zhou, Jun Liu, Ping Zhen, Weiwei Shen, Yanfeng Chang, Haoqiang Zhang, Qingsheng Zhu, Xusheng Li

Abstract

Background: The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly.

Methods: From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3-99.1 years [(83.7 ± 5.6) years]. The patients' bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed.

Results: All patients were followed for 12.5-36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05).

Conclusion: Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery.

Trial registration: Registration Number: ChiCTR1900022846 . Reg Date:2019-04-26 00:27:33 Retrospective registration.

Keywords: Elderly; Femoral intertrochanteric fracture; Hemiarthroplasty; Proximal femoral nail anti-rotation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The patient was an 81-year-old male who accidentally fell on the ground while walking on March 25, 2012, causing left hip pain andlimited mobility. a. X-ray examination showed left comminuted intertrochanteric fracture and liberation of the great trochanter and lesser trochanter; b. Physical examination: adduction and internal rotation deformity was observed inhis left hip; left leg was approximately1.5 cm shorter than the right leg; percussion pain inhis large rotator and vertical percussion pain inhis limb. On March 27, 2012, he was treated with left intertrochanteric fracture fixation (PFNA) under nerve block anesthesia. Anteroposterior pelvis and lateral femoral examination after the operation showed good fracture alignment and satisfactory fixation; c, d. X-ray examination 2 years after the operation showed that the trochanteric fracture has healed without loosening or leakage of internal fixation
Fig. 2
Fig. 2
The patient was a 94-year-old male whofell from a height accidentally on November 12, 2011, causing left hip pain and limited activity. a. X-ray examination showed a left intertrochanteric comminuted fracture; b. Physical examination: mild adduction rotation deformity ofhis left hip; the left limb was approximately2cm shorter than the right limb. On November 15, 2011, he underwent left cementless bipolar hemiarthroplasty (CPH) under spinal anes thesia and Kirschner wire bunched fixation. Postoperative X-ray examination showed good positioning of the fracture and satisfactory positioning of the femoral head prosthesis and wire fixation; c, d. X-ray examination 2 years after the operation showed the left femoral head prosthesis in a good position, with no loosening or dislocation

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