Comparative Efficacy Of PFNA And Anatomic Proximal Femoral Locking Plate For The Treatment Of Unstable Type Of Intertrochanteric Fractures

Objective: To compare the clinical results of unstable type of intertrochantericfractures using proximal femoral nail antirotation (PFNA) and anatomic proximalfemoral locking plate (ALP).Methods: A review study was conducted on66patients of unstable type ofintertrochanteric fractures treated with PFNA and anatomic proximal femoral lockingplate in our hospital from January2009to January2011.38cases treated with PFNAand28cases with ALP. According to the AO classification, all of the cases were typeA2and A3. We evaluated incision length, operation time, intra-operative bleeding,post-operative drainage volume, weight bearing-time, internal fixation quality, hip varusdeformity and other post-operative complications,fracture healing time and hipfunctions recovery one year postoperatively (Harris score) to observe the clinical effectof both methods.Results: Among66cases,60patients were followed up successfully with a meanperiod of18.2(12to24) months.3cases in PFNA group and3cases in ALP diedwithin12months discharge from hospital. All records index used the SPSS17.0software to do statistical analysis:①In terms of incision length, operation time,intra-operative bleeding, post-operative drainage volume, weight bearing-time, therewas significant difference (P<0.05). In terms of fixator loose rate and hip varusdeformity rate and other post-operative complications rate, there were significantdifference. We had the Statistical data by SPSS17.0（χ~2=5.326,P=0.041<0.05）.So, ascompared to ALP, PFNA could have a shorter incision length, a shorter procedure, lessintra-operative blood loss and post-operative drainage volume, earlier weight bearing,less post-operative complication rate.②In term of union time of fracture, there were no significant difference was found between PFNA and ALP（P=0.156>0.05）. In terms ofrecovery of hip function(Harris score) one year postoperatively, according to the Harrisscore (full marks100points), PFNA groups: excellent (≥90points) had24cases, good(80-89) had12cases, fair (70-79) had2cases, and poor (<70points) had0case,the rate of optimal and good was94.7%. ALP group: excellent (≥90points) had17cases, good (80-89) had9cases, fair (70-79) had2cases, and poor (<70points)had0case, the rate of optimal and good was92.9%. There was no significantdifferences in the recovery of hip function one year postoperatively between the2groups by SPSS17.0（χ~2=0.964,P=0.858,P>0.05）．Conclusion:1.Two different fixation methods for unstable type ofintertrochanteric fractures can achieve good clinical effect with their own characteristics.2.PFNA is more suitable for unstable type of intertrochanteric fracture in addition togreater trochanter comminuted fracture in A2type.3.Anatomic proximal femorallocking plate is more suitable for greater-trochanter comminuted fracture orgreater-trochanteric fractures with longitudinal morphology in A2type.4.Incomparison, PFNA can achieve shorter incision length, more simple operation, morereliable fixation, earlier weight bearing, better quality of patient’s life, smallerpost-operative complication rate; But, because of the fixation quality often not enough,the screws of anatomic proximal femoral locking plate will break easily during earlywalking. Therefore PFNA is much more suitable for the aged and poor medicalcondition patients who do not have greater tolerance of surgical procedure.