Comparison of proximal femur antirotation nail and partial hip arthroplasty in surgical treatment of unstabil intertrochanteric femoral fractures

Unstable intertrochanteric fractures in elderly end up with high amount of morbidity and mortality. These fractures can be treated surgically by hemi-arthroplasty or internal fixation by intramedullary hip nail-screw/blade combinations. Hemiarthroplasty has advantage of early and unrestricted weight bearing, whereas hip nail-blade fixation has the advantage of shorter surgery time and less morbidity due to limited surgical dissection. Limited evidence is available regarding long term benefits and results. In this study we aimed to compare the results of unstable intertrochanteric hip fractures treated with both methods regarding mortality and morbidity. 189 intertrochanteric hip fractures treated surgically between 2004-2014 at Bulent Ecevit University, Department of Orthopaedics and Traumatology were reviewed. All patients were treated surgically by either partial hip arthroplasty (PHA) or proximal femoral nail-antirotation (PFN-A). Of these 189 cases, 114 were found to be unstable fractures. 53 unstable fracture cases (27 PHA, 26 PFNA) with a minimum follow-up of 6 months with radiological and clinical evaluation data were included in the study. Demographics, ASA scores, intensive care unit hospitalization status, hemoglobin values, post-operative drainage volumes, transfusion rates and amounts, overall hospitalization time, Harris hip scores at follow up and mortality status were collected and analyzed. No difference was observed regarding age, sex, pre-op hemoglobin values and ASA risk scores. Intensive care hospitalization was significantly higher in PHA group (55,5 % in PHA vs. 23 % in PFNA). Blood transfusion rate was significantly higher in PHA group (17 PHA cases vs. 8 PFNA cases). Hospital stay was significantly shorter in PFNA group (PFNA: 7 days vs PHA: 11 days). Mortality at the end of follow up was significantly higher in PHA group than PFNA group (44,5% vs. 23,1%). Mean Harris hip scores of remaining cases were found to be higher in PFNA cases than PHA cases (80,1 vs 67). (p<0,05) Results of our study were concordant with previous studies in the literature. Proximal femoral nail-antirotation (PFNA) results with less overall morbidity and mortality than partial hip arthroplasty in unstable intertrochanteric hip fractures of elderly. Key Words: Femoral İntertrochanteric Fracture, Partial Hip Arthroplasty, Proximal Femur Antirotation Nail