The Asia proximal femoral nail antirotation versus the standard proximal femoralantirotation nail for unstable intertrochanteric fractures in elderly Chinese patients

摘要

Background. - The best options of internal fixation for unstable intertrochanteric fractures in elderly Chi-nese patients remain controversial. The Asia proximal femoral nail antirotation (PFNA-II) was specificallydesigned for Asian patients, which could be more effective than the regular proximal femoral nail antiro-tation (PFNA). Compared to PFNA, whether PFNA-II is associated with shorter operative time and lowerrates of complications is unknown. Hypothesis. - The rate of complications using PFNA-II is lower than PFNA for the treatment of unstableintertrochanteric fractures in elderly Chinese patients, and the operation using PFNA-II is quicker.Materials and methods. - Between June 2008 and December 2011,188 patients with unstable intertro-chanteric fractures treated with the PFNA-II (n = 118) or PFNA (n = 70) were retrospectively evaluated.Follow-up evaluations were performed at 1,3, 6, 9 and 12 months, and every year thereafter. Accordingto residual valgus-varus deformation, the quality of the fracture reduction was graded as poor (>10°deformation), acceptable (5 to 10° deformation), or good (< 5° deformation). The operative time, intrao-perative blood loss, overall time of fluoroscopy, blood transfusion volume, postoperative drainage, lengthof hospital stay and postoperative complications were recorded. Results. - The mean operative time in the PFNA-II group was significantly shorter than that in thePFNA group (66.25 ±13.15 vs. 79.50±21.12minutes; P<0.05), intraoperative blood loss was smaller(131.86±69.16 vs. 162.14±66.18 ml; P<0.05), and fewer local complications were observed (25% vs.46%; P<0.05). There was no significant difference in the postoperative blood transfusions, overall timeof fluoroscopy, postoperative drainage, length of hospital stay, fracture reduction, the position of theimplant and tip apex distance between the two groups. At follow-up, no significant difference was foundbetween the two groups in Harris hip score (HHS) (86.19 ± 6.53 vs. 85.27 ± 5.47; P> 0.05), visual analoguescale (VAS) (0.87 ±0.85 vs. 0.97 ± 0.87; P>0.05). Discussion. - Due to its special design for the Asian population, PFNA-II offers a better match with theChinese people's proximal femur anatomic structure. This study showed that the rate of complicationsusing PFNA-II is lower than PFNA for the treatment of unstable intertrochanteric fractures in elderlyChinese patients, and the operation time is shorter.Level of evidence. - Level III case control study.