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

Özet

Objective: The aim of this study was to retrospectively compare the radiological and clinical results of intertrochanteric fracturestreated 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 intraoperativefracture 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 sixconditions were observed for over 2 years: AO Foundation/Orthopaedic Trauma Association 31-A1 and 31-A2 trochantericfractures; Singh index grade ≥ 3; positive or neutral medial cortical support position with slightly valgus reduction; possiblecompression of more than one cortical bone in the anterior or medial region of the fracture site based on preoperative imagingtest; blade position within the center-center; andtip-apex distance of < 25 mm. During the follow- up periods, changes of pain andtime to fracture union were evaluated clinically, and the lateral extension distance (for screw back-up) was evaluatedradiologically 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 meanoperation time was 68 (range = 40-100) min in group A and 71 (range = 40-105) min in Group B (P = 0.521). Intraoperative bloodloss 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 byvisual 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 thePFNA 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) mm in Group A and 2.6 (range = 0.7-4.6) mm in Group B, showing significantdifference (P = 0.001). The average fracture union time was 16.7 (range = 14-20) weeks in Group A) and 19.7 (range = 16-22) weeksin 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).pConclusion: If all the six conditions are met, IOFC seems to appropriate for AO/OTA 31-A1 and 31-A2 intertrochanteric fractureswith the smaller postoperative fracture gap and lateral protrusion of the blade, which may contribute to the shortening of fractureunion periods.Level of Evidence: Level IV, Therapeutic Study