A comparative study of clinical and radiological outcomes following long and short proximal femoral nail (PFNA) fixation in patients with subtrochanteric fractures of the proximal femur

A Comparative Study of Clinical and Radiological Outcomes Following Long and Short Proximal Femoral Nail (PFNA) Fixation in Patients with Subtrochanteric Fractures of the Proximal Femur Aim: The objective of this study is to compare the clinical and radiological outcomes of long and short proximal femoral nail (PFNA) implants in patients over 65 years of age with similar demographic characteristics, comorbidities, and fracture patterns, predominantly osteoporotic. Materials and Methods: A retrospective study was conducted on patients who underwent surgical treatment for subtrochanteric fractures between February 2013 and July 2023 at our clinic. Patients who underwent PFNA fixation and had a minimum of one-year follow-up, with similar age, gender, comorbidities, and fracture type, were randomly selected and divided into two groups: long and short PFNA. Patients with incomplete medical records, less than one-year follow-up, combined plate-screw or arthroplasty fixation, or those who were not operated on due to medical reasons or patient/family refusal were excluded. Patients in both groups were compared in terms of fracture mechanism, type, classification, operative time, complications, reduction quality, length of hospital stay, postoperative radiological measurements, follow-up duration, Harris hip score, visual analog scale score, and Parker mobility score. Data was analyzed using IBM SPSS 28. Results:A total of 61 patients with subtrochanteric fractures who underwent either long or short proximal femoral nail (PFNA) fixation were included in this study. Patients were randomly assigned to either the long(n=33) or short(n=28) PFNA group, matched for gender, age, comorbidities, fracture type, and mechanism of injury. The primary outcome was operative time, which was found to be significantly shorter in the short PFNA(average 108.36 min) group compared to the long PFNA(average 137.03 min) group. There were no significant differences between the short and long PFNA groups in terms of reduction quality, which was classified as excellent, good, or poor. Additionally, there were no significant differences in Kalkar reference tip apex distance, visual analog scale scores, Harris hip scores, or Parker mobility scores. Furthermore, there were no significant differences in postoperative complications or the distribution of specific complications between the two groups. There was no significant difference between the two groups in terms of complications, including infection, avascular necrosis, shortening, and postoperative heterotopic ossification. Furthermore, there was no significant difference in follow-up duration between the short and long PFNA groups. Conclusion: In our study comparing long and short proximal femoral nail (PFNA) implants for subtrochanteric fractures, the groups were well-matched in terms of age, gender, comorbidities, mechanism of injury, and fracture type. There were no significant differences between the groups regarding fracture type or classification. Operative time was significantly shorter in the short PFNA group. Reduction quality was similar between the groups. Radiographic measurements, such as Kalkar reference tip apex distance, were comparable in both groups. Clinical scores, including Harris hip score, visual analog scale, and Parker mobility score, did not differ significantly. Although the short PFNA group had a lower complication rate, this difference was not statistically significant. The long PFNA group had a longer follow-up duration, but this difference was also not statistically significant. Our comparative analysis of short and long PFNA implants revealed no significant differences in surgical, clinical, or radiological outcomes. While the short stem group demonstrated a shorter operative time, it is essential to consider individual patient factors, such as comorbidities, fracture characteristics, and surgeon experience, when selecting the most appropriate treatment. Key Words: Subtrochanteric fracture, PFNA, Long, Short