J Korean Orthop Assoc.  2016 Dec;51(6):493-502. 10.4055/jkoa.2016.51.6.493.

A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures

• Chung PH
• Kang S
• Kim JP
• Kim YS
• Lee HM
• Back IH
• Eom KS

• KMID: 2364301
• DOI: http://doi.org/10.4055/jkoa.2016.51.6.493

Abstract

PURPOSE
This study compared the clinical results between compression hip screw (CHS) and proximal femoral nail (PFN) after the treatment of AO/OTA A2.2 intertrochanteric (ITC) fractures.
MATERIALS AND METHODS
We retrospectively reviewed 125 cases of AO/OTA A2.2 ITC fracture, treated with either CHS (group I, 34 cases) or PFN (group II, 91 cases) between March 1994 and December 2014. We evaluated the mean operation time, estimated blood loss and transfusion, hospitalization stay, sliding length of lag screw, tip-apex distance, change of neck shaft angle, mean union time, weight bearing time, mechanical failure, and ambulatory ability by the Parker and Palmer mobility scores.
RESULTS
Operative time, estimated blood loss, transfusion, hospitalization stay, tip-apex distance, change of neck-shaft angle, and Parker and Palmer mobility scores were not significantly different between the two groups (p>0.05). However, the mean sliding length of lag screw was 8.15 mm and 3.94 mm for group I and II, respectively, the mean union time was 16.85 weeks and 15.57 weeks, respectively, and the mean full weight bearing time was 4.54 weeks and 2.31 weeks, respectively. The mean sliding length of lag screw, union time, and full weight bearing time all had statistical significance (p<0.05). There were a total of 3 cases of postoperative complications in group I and 4 cases in group II.
CONCLUSION
We conclude that PFN is more reliable than CHS as a treatment method for AO/OTA A2.2 intertrochanteric fracture.

Keyword

femur; intertrochanteric fractures; compression hip screw; proximal femur nail

MeSH Terms

Femoral Fractures*
Femur
Hip Fractures
Hip*
Hospitalization
Methods
Neck
Operative Time
Postoperative Complications
Retrospective Studies
Weight-Bearing

Figure

• 

  Figure 1 A 65-year-old man with intertrochanteric fracture fixed with proximal femoral nail. (A) Initial radiograph shows unstable intertrochanteric fracture of the femur with detached lesser trochanter. (B) Initial three-dimensional computed tomography shows AO/OTA 31-A2.2 fracture. (C) Immediate postoperative radiograph shows acceptable reduction and internal fixation with proximal femoral nail. (D) At postoperative 9 months, the radiograph with external rotation shows complete union of the fracture site with solid union of the lesser trochanter.

• 

  Figure 2 A 62-year-old man with intertrochanteric fracture fixed with compression hip screw. (A) Initial radiograph shows unstable AO/OTA 31-A2.2 fracture of the femur. (B) Immediate postoperative radiograph shows acceptable reduction and internal fixation with compression hip screw. (C) At postoperative 4 weeks, the radiography shows sliding of lag screw and medialization of the distal femur. (D) Radiography obtained 2 years after the initial surgery shows removal of compression hip screw and solid union of fracture site.

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