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Comparative outcomes of PFN vs PFNA2 nailing for osteoporotic unstable intertrochanteric fractures in the elderly.

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Title: Comparative outcomes of PFN vs PFNA2 nailing for osteoporotic unstable intertrochanteric fractures in the elderly.
Alternate Title: Resultados comparativos del empleo de clavos PFN frente a PFNA2 para fracturas osteoporóticas inestables intertrocantéricas en ancianos.
Authors: Dahuja, A.1, Khatri, K.1, Kaur, R.1 dr.rashmeet@gmail.com, Bansal, K.1, Singh, S.1
Source: Acta Ortopédica Mexicana. sep/oct2024, Vol. 38 Issue 5, p298-306. 9p.
Subjects: OSTEOPOROSIS, INTRAMEDULLARY rods, INTRAMEDULLARY fracture fixation, OLDER people, FEMUR
Abstract (English): Introduction: fixation of unstable intertrochanteric fractures presents a significant challenge, especially in the context of osteoporosis. Intramedullary implants have been established as superior to plate constructs. Our aim is to compare the complications and clinical outcomes of the Proximal Femur Nail (PFN) and Proximal Femur Nail Antirotation-2 (PFNA2) in managing unstable intertrochanteric fractures. Material and methods: a total of 212 patients meeting inclusion and exclusion criteria underwent fixation of trochanteric fractures using either a standard PFN (n = 110) or PFNA2 (n = 102). Their intraoperative and postoperative clinical and radiographic data were evaluated along with the quality of fixation. Data analysis was performed using the student's t-test, χ² test, and Mann-Whitney U test. Results: PFNA2 demonstrated more favorable outcomes compared to PFN in terms of a better intraoperative profile, functional outcomes (PFNA2: PFN = 82:75), and fewer implant-related complications. Significant issues in the PFN group included screw backout, guidewire breakage, and proximal protrusion of the nail tip. In contrast, locking mechanism failure and lateral screw prominence were significant problems in the PFNA2 group. Conclusion: PFNA2 is the preferred implant for managing osteoporotic unstable intertrochanteric fractures, given the bone's weak inherent tendency to secure the implant. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Introducción: la fijación de fracturas intertrocantéreas inestables presenta un desafío importante, especialmente en el contexto de la osteoporosis. Se ha demostrado que los implantes intramedulares son superiores a las construcciones con placas. Nuestro objetivo es comparar las complicaciones y los resultados clínicos del clavo de fémur proximal (PFN) y el clavo de fémur proximal antirotación-2 (PFNA2) en el tratamiento de fracturas intertrocantéreas inestables. Material y métodos: un total de 212 pacientes que cumplían con los criterios de inclusión y exclusión se sometieron a fijación de fracturas trocantéricas utilizando un PFN estándar (n = 110) o PFNA2 (n = 102). Se evaluaron sus datos clínicos y radiográficos intraoperatorios y postoperatorios junto con la calidad de la fijación. El análisis de los datos se realizó mediante la prueba t de Student, la prueba de χ² y la prueba U de Mann- Whitney. Resultados: PFNA2 demostró resultados más favorables en comparación con PFN en términos de un mejor perfil intraoperatorio, resultados funcionales (PFNA2: PFN = 82:75) y menos complicaciones relacionadas con los implantes. Los problemas importantes en el grupo PFN incluyeron el retroceso del tornillo, la rotura de la guía y la protrusión proximal de la punta del clavo. Por el contrario, la falla del mecanismo de bloqueo y la prominencia lateral del tornillo fueron problemas importantes en el grupo PFNA2. Conclusión: PFNA2 es el implante preferido para el tratamiento de fracturas intertrocantéreas inestables osteoporóticas, dada la débil tendencia inherente del hueso a asegurar el implante. [ABSTRACT FROM AUTHOR]
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Database: MedicLatina
Description
Abstract:Introduction: fixation of unstable intertrochanteric fractures presents a significant challenge, especially in the context of osteoporosis. Intramedullary implants have been established as superior to plate constructs. Our aim is to compare the complications and clinical outcomes of the Proximal Femur Nail (PFN) and Proximal Femur Nail Antirotation-2 (PFNA2) in managing unstable intertrochanteric fractures. Material and methods: a total of 212 patients meeting inclusion and exclusion criteria underwent fixation of trochanteric fractures using either a standard PFN (n = 110) or PFNA2 (n = 102). Their intraoperative and postoperative clinical and radiographic data were evaluated along with the quality of fixation. Data analysis was performed using the student's t-test, χ² test, and Mann-Whitney U test. Results: PFNA2 demonstrated more favorable outcomes compared to PFN in terms of a better intraoperative profile, functional outcomes (PFNA2: PFN = 82:75), and fewer implant-related complications. Significant issues in the PFN group included screw backout, guidewire breakage, and proximal protrusion of the nail tip. In contrast, locking mechanism failure and lateral screw prominence were significant problems in the PFNA2 group. Conclusion: PFNA2 is the preferred implant for managing osteoporotic unstable intertrochanteric fractures, given the bone's weak inherent tendency to secure the implant. [ABSTRACT FROM AUTHOR]
ISSN:23064102
DOI:10.35366/117378