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Objective: The aim of this study was to retrospectively compare the radiological and clinical results of intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) that were either intraoperatively compressed or non-compressed.
Methods: Ninety-four patients (64 female, 30 male; mean age = 77.6 years; age range = 68–81) who underwent intraoperative fracture compression (IOFC) (94 hip joints, group A) and 88 patients (64 female, 24 male; mean age = 77.1 years; age range = 67– 80) who underwent postoperative impaction (POI) alone (88 hip joints, group B) from2012 to 2017 met the following six conditions were observed for over 2 years: AO Foundation/Orthopaedic Trauma Association 31-A1 and 31-A2 trochanteric fractures; Singh index grade ≥ 3; positive or neutral medial cortical support position with slightly valgus reduction; possible compression of more than one cortical bone in the anterior or medial region of the fracture site based on preoperative imaging test; blade position within the center-center; andtip-apex distance of < 25 mm. During the follow- up periods, changes of pain and time to fracture union were evaluated clinically, and the lateral extension distance (for screw back-up) was evaluated radiologically which measuredbetween the lateral end of the screw and lateral edge of the intramedullary nail.
Results: The mean follow-up was 38.4 (range = 24-48) months in Group A and 36.7 (24-48) months in Group B. The mean operation time was 68 (range = 40-100) min in group A and 71 (range = 40-105) min in Group B (P = 0.521). Intraoperative blood loss was 78 (range = 50-110) mL in Group A and 81 (range = 50-100) mL in Group B (p=0.715). The mean fluoroscopy time was 2.8 (range = 2.2-3.5) min in Group A and 2.6 (range = 2.1-3.5) min in Group B (P = 0.631). The acute phase pain scores measured by visual analog scale at postoperative 3 months were 35.5 in Group A and 37.6 in Group B (P = 0.073). The lateral extension of the PFNA blade showed significant difference at 24 months after surgery (Group A, 3.6±3.1 mm; group B, 7.8±3.7 mm, P = 0.017). Fracture gaps after surgery were 1.8 (range = 0.5-2.5)mmin Group A and 2.6 (range = 0.7-4.6)mmin Group B, showing significant difference (P = 0.001). The average fracture union time was 16.7 (range = 14-20) weeks in Group A) and 19.7 (range = 16-22) weeks in Group B (P = 0.065). The mean Harris Hip Scores at postoperative 24 months were 84.3 (range = 65-100) in Group A and 85.5 (range= 69-100) in Group B (P = 0.545).p
Conclusion: If all the six conditions are met, IOFC seems to appropriate for AO/OTA 31-A1 and 31-A2 intertrochanteric fractures with the smaller postoperative fracture gap and lateral protrusion of the blade, which may contribute to the shortening of fracture union periods.
Level of Evidence: Level IV, Therapeutic Study
Cite this article as: Cho HM, Park JY, Kwon KH, Lee Y. Is it advantageous to use the intraoperative compression option of proximal femoral nail antirotation in the treatment of osteoporotic intertrochanteric fractures? A retrospective comparative study. Acta Orthop Traumatol Turc 2021; 55(4): 285–292.