Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures

BACKGROUND: Hip nailing is frequently used to treat unstable intertrochanteric femoral fractures (ITF) in elderly patients. In this retrospective study, we compared the functional and radiological results, and the complications, of patients treated using proximal femoral nails (PFN) with an integrated, interlocking, compression lag screw, or two separate lag screws, which allow linear compression at the fracture site.
METHODS: A total of one hundred and eighteen patients were operated on for AO/OTA 31-A2 ITF between May 2010 and April 2012, and eighty-two of these patients, for whom sufficient follow-up data and documentation were available, were included into the study. PFNs with interlocking, integrated lag screws (Group I) were used in forty-four patients, and PFNs with two separate lag screws (Group II) in thirty-eight. Outcome parameters were the extent of varus collapse and leg length discrepancy on radiographs, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris hip scores (HHS) as functional results.
RESULTS: Mean follow-up duration was 20 months (range, 12–36 months); fractures healed in all patients. Mean varus collapse values were 2.03±5.68° and 5.21±5.27° (p=0.01), Harris hip scores 73.2±11.65 and 74.72±11.15 (p=0.54), and WOMAC scores 70.78±11.41 and 71.78±11.19 (p=0.69) in Groups I and II, respectively. No difference was detected between the groups in terms of outcome parameters or complication rate.
CONCLUSION: In the treatment of ITF, PFNs with an integrated, interlocking, compression lag screw, or two separate lag screws did not differ in terms of functional and radiological results or complication rate.

Ýntertrokanterik femur kýrýklarýnýn tedavisinde iki farklý proksimal femur civisinin karþýlaþtýrýlmasý

AMAÇ: Kalça çivileme (PFN) yaþlý hastalardaki instabil intertrokanterik femur kýrýklarýnýn (ITF) tedavisinde sýklýkla kullanýlmaktadýr. Bu geriye dönük çalýþmada, kýrýk sahasýnda kompresyona izin veren birbirine entegre, birbirine kilitlenebilir kompresyon lag vidasý kiti ya da iki ayrý lag vidasý kullanýlan PFN ile tedavi edilmiþ olan hastalarýn fonksiyonel, radyolojik sonuçlarý ve komplikasyonlarý karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: Mayýs 2010 ve Nisan 2012 tarihleri arasýnda, AO/OTA 31–A2 ITF kýrýðý için ameliyat edilmiþ olan 118 hastadan takipleri ve kayýtlarý yeterli olan 82’si incelendi. Kompresyon yapabilen, birbirine kilitlenebilir, entegre lag vidasý kiti olan PFN (Grup I) 44 hastada, iki ayrý lag vidasý olan PFN ise (Grup II) 38 hastada kullanýldý. Sonuç parametreleri radyolojik olarak varusta çökme ve bacak boyu eþitsizliði, fonksiyonel olarak da Batý Ontario ve McMaster Üniversiteleri artrit indeksi (WOMAC) ve Harris kalça skorlarý (HHS) idi.
BULGULAR: Ortalama takip süresi olan 20 (12–36) ayda tüm kýrýklar iyileþti. Grup I ve Grup II’de sýrasýyla, ortalama varus çökmesi 2.03° ve 5.21° (p=0,01), ortalama HHS 73,2 ve 74,72 (p=0,54), ortalama WOMAC skorlarý ise 70,78 ve 71,78 (p=0,69) olarak bulundu. Sonuç parametreleri ve komplikasyon oranlarý bakýmýndan gruplar arasýnda anlamlý bir fark görülmedi (p>0.05).
TARTIÞMA: Ýntertrokanterik femur kýrýklarýnýn tedavisinde, birbirine entegre ve birbirine kilitlenebilir kompresyon lag vidasý veya iki ayrý lag vidasý kullanýlan PFN’ler arasýnda fonksiyonel, radyolojik sonuçlar ve komplikasyon oranlarý açýsýndan fark bulunmamaktadýr.