Key result
In patients with unstable trochanteric femur fractures, treatment with the proximal fixation nail anti-rotation resulted in significantly less mean blood loss compared to the gamma nail (217.3 ml vs 272.5 ml, p=0.0071).
Why the study?
Does PFNA improve surgical outcomes and reduce complications compared to Gamma nail in patients with unstable trochanteric femur fractures?
Observational (n=100)
No
Does PFNA improve surgical outcomes and reduce complications compared to Gamma nail in patients with unstable trochanteric femur fractures?
Absolute Event Rate: 217.3% vs 272.5%
p-value: p=0.0071
PFNA and Gamma nail are both effective for unstable trochanteric fractures, but PFNA is associated with significantly less blood loss and shorter fluoroscopy time.
PFNA was associated with less blood loss than gamma nail; leaves open whether it improves overall outcomes in unstable trochanteric fractures.
The basic purpose of study is to find out advantage and disadvantage of fixation nail anti rotation and gamma nail in trochanteric fracture of femur. I observed about 100 cases of unstable fracture of femur in my hospital which was treated by anti rotational fixation nail of two years and took some data of gamma nail .I did observe that in PFNA blood loss was very less and duration of surgery was short and PFNA is very good in osteoporotic patients in compare to the gamma nail 3. Reduction of the fracture was considered good in both cases and radio graphically both device position was good postoperatively. Intra operative complication was comparatively more in gamma nail than anti rotational fixation nail such as shaft fracture of the femur, blood loss, duration of surgery. Post operative complication was not seen in both cases such as nonunion, malunion.so after studying both cases I did not found so much difference between these two devices which are used in trochanteric fracture by the orthopedic surgeons but very few advantage with the proximal fixation nail.So the both intrameddulary nailing device was good compare to the extrameddulary device like dynamic screw in trochanteric fracture of femur. 1, 2 Recent study find out some complication with gamma nail like shaft of femur fracture 3 , fixation failure 4 , distal locking complication need to reoperate but they are very few cases . 3, 4 Gamma nail are still widely used despite of having such complication. The comparative data of gamma nail and PFNA result that PFNA is little better device in unstable proximal fracture. 2, 5 Something about gamma nails which is used in my hospital since last three years. The proximal femoral nail anti rotation (PFNA; Synthes, Oberdorf, Switzerland) was developed by AO/ASIF (Davos, Switzerland) as an alternative to the proximal femoral nail. It has small distal shaft diameter which causes less stress co centration of tip .The PFNA blade compact the cancellous bone and provide stability and prevent retard rotation and varus collapse. Since its introduction, so many clinical studies have shown very good result with very little intraoperative problems and post operative complication. 6
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sahamim et al. (2014) conducted an observational in Unstable proximal trochanteric fracture of femur (n=100). Proximal fixation nail anti-rotation (PFNA) vs. Gamma nail (GN-3) was evaluated on Mean blood loss (p=0.0071). In patients with unstable trochanteric femur fractures, treatment with the proximal fixation nail anti-rotation resulted in significantly less mean blood loss compared to the gamma nail (217.3 ml vs 272.5 ml, p=0.0071).
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