Cemented Hemiarthroplasty Versus Proximal Femoral Nail Antirotation in the Management of Intertrochanteric Femoral Fractures in the Elderly: a Case Control Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2021 Oct 6

PMID 34610813

Citations 5

Authors

Zhuangzhuang Jin

Shuoyan Xu

Yue Yang

Yingliang Wei

Yicheng Tian

Ziyuan Wang

Lunhao Bai

Affiliations

Soon will be listed here.

Abstract

Background: The treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. Hence, this study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly.

Methods: Overall, 99 patients (81.09 ± 8.29 years; 68 women) underwent HA or PFNA from January 2016 to May 2020. IFF were classified according to the Arbeitsgemeins für Osteosynthesefragen (AO) classification. The difference in underlying diseases, the American Society of Anesthesiologists (ASA) grade, Singh index, Harris scores, surgical time, intraoperative bleeding, postoperative blood test results, postoperative number of days to partially bearing weight, and survival outcomes were analyzed. Postoperative follow-ups were performed every 3 months.

Results: There was no significant difference in the AO classification, underlying diseases, ASA grade, Singh index, surgical time, and survival outcomes of the HA (45 patients) group and PFNA group (54 patients). The HA group was associated with earlier partial weight-bearing (HA: 4 [2 ~ 4.5] days, PFNA: 10 [8~14] days). It also had a higher total Harris score than the PFNA group at the 6-month follow-up visit (HA: 86.8 [81.90 ~ 90.23], PFNA: 83.48 [75.13 ~ 88.23]). Harris scores decreased more in patients aged ≥90 years in the PFNA group than in the HA group. The postoperative stress recovery rate in the HA group was faster based on postoperative blood test results.

Conclusions: PFNA and HA have good therapeutic effects in the treatment of IFF. The advantages of HA were reflected in short-term weight bearing, faster recovery from stress, and better joint function in the long term. This advantage is more obvious in the patient population aged over 90 years. Therefore, we suggest that surgeons should consider the benefit of HA in the treatment of IFF among the elderly.

Trial Registration: Chinese Clinical Trial Registry, ChiCTR2000035814. Registered 17 August 2020, https://www.chictr.org.cn/showproj.aspx?proj=57083.

Citing Articles

Construction and validation of a nomogram prediction model for internal fixation failure after proximal femoral anti-rotation intramedullary nailing in the treatment of intertrochanteric fractures of the femur.

Wu L, Zhang T, Li J, Huang H, Zhou C, Li X Medicine (Baltimore). 2025; 103(47):e40575.

PMID: 39809193 PMC: 11596523. DOI: 10.1097/MD.0000000000040575.

Risk factors for excessive lateral migration of the blade in proximal femoral nail anti-rotation in elderly patients with intertrochanteric femur fracture.

Wang Y, Jiang H, Ma G, Song W, Zhu F Am J Transl Res. 2024; 16(10):5637-5648.

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Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation.

Cha X, Zhou Q, Li J, Xu H, Xu W, Li J BMC Musculoskelet Disord. 2024; 25(1):405.

PMID: 38783225 PMC: 11112938. DOI: 10.1186/s12891-024-07334-z.

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review.

Turabi R, Wyatt D, Guerra S, OConnell M, Khatun T, Sageer S Osteoporos Int. 2023; 34(7):1193-1205.

PMID: 37016146 DOI: 10.1007/s00198-023-06735-5.

Effect of proximal femoral nail antirotation on clinical outcome, inflammatory factors and myocardial injury markers in patients with femoral trochanteric fracture.

Li K, Yang H, Jiang Z, Peng W, Zhou X Am J Transl Res. 2022; 14(7):4795-4803.

PMID: 35958501 PMC: 9360835.

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