Hong Man CHO, Ji Yeon PARK, Ki Hyun KWON, Young LEE

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

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

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