[Comparison of PFNA and InterTAN intramedullary nail in treating unstable femoral intertrochanteric fractures].

OBJECTIVE: To compare the clinical effects of PFNA and InterTAN for the treatment of unstable intertrochanteric fractures in the elderly patients.

METHODS: From April 2012 to February 2014, 113 elderly patients with unstable intertrochanteric fractures were treated by PFNA or InterTAN. There were 64 cases in PFNA group, including 25 males and 39 females with an average age of (73.3±6.5) years old (ranged, 66 to 85);while 49 cases in InterTAN group, including 20 males and 29 females with an average age of (74.2±5.4) years old (ranged, 65 to 85). According to the AO classification, there were 48 cases of type A2, 16 cases of type A3 in PFNA group and 37 cases of type A2, 12 cases with type A3 in InterTAN group. The time interval from injury ranged from 3 to 8 days with an average of 4.7±1.2. The blood loss, operation time, fluoroscopy time, lateral cortex fractures of the proximal femur, healing time of fracture, femoral shaft fractures, femoral head screw cut-out, necrosis of the femoral head, femoral neck shortening and Harris score of patients at the last follow-up were compared between the two groups.

RESULTS: Fifty-eight patients in PFNA and 44 patients in InterTAN were followed up for 14 to 18 months with an average of 16.3±1.2. Wound healing was satisfying during the follow-up. Significant differences were observed between the two groups regarding the blood loss, operation time, fluoroscopy time. The complication rate of femoral shaft fractures, femoral head screw cut-out and femoral neck shortening in InterTAN group was less than that in PFNA group, showing significant difference between the two groups ( P <0.05). At the latest follow-up, the average Harris scores were 90.7±5.1 in PFNA group and 90.4±3.9 in InterTAN group, there was no significant difference between the two groups( P >0.05).

CONCLUSIONS: InterTAN with stronger anti-rotation function is more suitable for patients with early weight-bearing and it reduces the incidence rates of hip varus, femoral head screw cut-out and femoral neck shortening. However, for those patients with osteoporosis or unfit for surgery, PFNA is a good option. As the limited follow-up duration, long-term effects of the two surgical methods needs to be further observed and studied.