Efficacy of femoral nail anti-rotation of helical blade in unstable intertrochanteric fracture.

OBJECTIVE We analyzed the comparative efficacy and long-term prognosis with proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) for the treatment of unstable intertrochanteric fractures, retrospectively. We determined the independent risk factors to guide subsequent surgery and improve the long-term quality of life. PATIENTS AND METHODS We selected 165 patients suffering from unstable intertrochanteric fracture from January 2010 to January 2015 in our hospital, including 89 treated with PFNA and 76 with DHS surgery. The duration of follow-up lasted from 10 months to 56 months (34.7 ± 8.5) on average. The patient demographics included gender, age, reasons for fracture, fracture type (Evans-Jensen), fracture time, comorbidities, surgical procedures (PFNA and DHS), the number of internal fixations, length, surgical time, blood loss, postoperative drug therapy, time for auxiliary external fixation and postoperative weight duration. The final indicators included adverse effects associated with implants; postoperative complications, clinical healing or bone healing time and functional score (Harris hip joint function scale, fine/excellent rate). RESULTS The differences in gender, age, fracture reasons, fracture type, fracture time and comorbidities were not statistically significant between the groups (p>0.05). However, the number of internal fixations, length, surgical time and blood loss, postoperative drug combination, time for auxiliary external fixation and postoperative weight duration were statistically significant (p<0.05). The effect of PFNA was more significant than that of DHS group. The prevalence of complications was reduced significantly. The patients treated with PFNA scored significantly higher on the Harris hip joint function scale than the DHS group (p<0.05). The independent risk factors affecting healing after surgery included fracture type, fracture time, different surgical procedures, the number of internal fixations and length. The independent risk factors affecting the follow-up Harris hip score included age, fracture type, comorbidities, different surgical procedures, postoperative drug combination, auxiliary external fixation, application time and postoperative weight duration. CONCLUSIONS Compared with DHS, PFNA resulted in better clinical outcomes and long-term prognosis of unstable intertrochanteric fractures.